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Wang D, Schneider-Thoma J, Siafis S, Burschinski A, Dong S, Wu H, Zhu Y, Davis JM, Priller J, Leucht S. Long-Acting Injectable Second-Generation Antipsychotics vs Placebo and Their Oral Formulations in Acute Schizophrenia: A Systematic Review and Meta-Analysis of Randomized-Controlled-Trials. Schizophr Bull 2024; 50:132-144. [PMID: 37350486 PMCID: PMC10754166 DOI: 10.1093/schbul/sbad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND HYPOTHESIS Long-acting injectable antipsychotic drugs (LAIs) are mainly used for relapse prevention but could also be advantageous for acutely ill patients with schizophrenia. STUDY DESIGN We conducted a systematic review and meta-analysis of randomized-controlled-trials (RCTs) comparing the second-generation long-acting injectable antipsychotics (SGA-LAIs) olanzapine, risperidone, paliperidone, and aripiprazole with placebo or their oral counterparts in acutely ill patients with schizophrenia. We analyzed 23 efficacy and tolerability outcomes, with the primary outcome being overall symptoms of schizophrenia. The results were obtained through random effects, pairwise meta-analyses, and subgroup tests. The study quality was assessed using the Cochrane-Risk-of-Bias-Tool version-1. STUDY RESULTS Sixty-six studies with 16 457 participants were included in the analysis. Eleven studies compared second-generation long-acting injectable antipsychotics (SGA-LAIs) with a placebo, 54 compared second-generation oral antipsychotics (SGA-orals) with a placebo, and one compared an SGA-LAI (aripiprazole) with its oral formulation. All 4 SGA-LAIs reduced overall symptoms more than placebo, with mean standardized differences of -0.66 (95% CI: -0.90; -0.43) for olanzapine, -0.64 (-0.80; -0.48) for aripiprazole, -0.62 (-0.76; -0.48) for risperidone and -0.42 (-0.53; -0.31) for paliperidone. The side-effect profiles of the LAIs corresponded to the patterns known from the oral formulations. In subgroup tests compared to placebo, some side effects were less pronounced under LAIs than under their oral formulations. CONCLUSIONS SGA-LAIs effectively treat acute schizophrenia. Some side effects may be less frequent than under oral drugs, but due to the indirect nature of the comparisons, this finding must be confirmed by RCTs comparing LAIs and orals head-to-head.
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Affiliation(s)
- Dongfang Wang
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Shimeng Dong
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hui Wu
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yikang Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA and Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Josef Priller
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Uribe ES, Mundo SEO, Garza RRM, Gonzalez-Colmenero FD, Sanchez LM, Cantu CBE, Arellano MM, Montemayor YYH, Morales PLC, Juarez SBM, Rojo-Garza SS. Comparative Safety of Long-Acting Injectable Antipsychotics: A Systematic Review and Network Meta-Analysis. Psychiatry Investig 2023; 20:1112-1125. [PMID: 38163650 PMCID: PMC10758324 DOI: 10.30773/pi.2022.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/29/2023] [Accepted: 06/22/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE To find the safety of long-acting injectable antipsychotics (LAIs) compared to each other, and/or placebo in the treatment of schizophrenia (SCZ) and/or schizoaffective disorder (SZA). METHODS We performed a systematic review and a network meta-analysis of randomized controlled trials (RCTs) comparing the safety of LAIs versus other LAIs or placebo in adults diagnosed with SCZ or SZA. The primary outcomes were treatment emergent adverse events (TEAEs), serious treatment emergent adverse events (STEAEs), and deaths. The secondary outcomes included treatment discontinuations due to adverse events and all-cause discontinuations. RESULTS Seventeen RCTs were included (n=7,908). There were no significant differences between LAIs and placebo in the risk of presenting TEAEs. LAIs had a significant lower risk of presenting STEAEs except for aripiprazole. No significant differences in deaths were found. LAIs showed a significant protective effect against all-cause discontinuation, except for haloperidol. Only aripiprazole had a significantly lower risk of treatment discontinuation due to adverse events. CONCLUSION We found no significant differences in the risk of presenting TEAEs between LAIs and placebo. The majority of LAIs had a significantly lower risk of presenting STEAEs than placebo. Development of international guidelines for the report of safety outcomes related to antipsychotics especially for LAIs in clinical trials could minimize report and interpretation biases and improve the accuracy of posterior meta-analysis.
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Affiliation(s)
- Erasmo Saucedo Uribe
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Samuel Enrique Olivares Mundo
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Raul Ricardo Medrano Garza
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Fernando Diaz Gonzalez-Colmenero
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Lorena Martinez Sanchez
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Cesar Bigran Espinosa Cantu
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Martin Moreno Arellano
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Yessica Yaneth Herrera Montemayor
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Centro de Neurociencias Avanzadas UANL, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
| | - Patricia Lizeth Castillo Morales
- Department of Psychiatry, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, México
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Samantha Berenice Medrano Juarez
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
| | - Sandra Sabrina Rojo-Garza
- Plataforma INVEST Medicina UANL-Ker Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, México
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Bunting SR, Chalmers K, Yohanna D, Lee R. Prescription of Long-Acting Injectable Antipsychotic Medications Among Outpatient Mental Health Care Service Providers. Psychiatr Serv 2023; 74:1146-1153. [PMID: 37042107 DOI: 10.1176/appi.ps.20220586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Long-acting injectable antipsychotic medications (LAIAPs) are a valuable and underused treatment for patients with chronic mental illnesses such as schizophrenia and bipolar disorder. This study aimed to examine prescription patterns of LAIAPs among outpatient mental health care service providers in the United States. METHODS The authors conducted a secondary analysis of the 2020-2021 National Mental Health Services Survey to assess the percentage of outpatient mental health care service providers (N=9,433) that prescribed LAIAPs to patients. Descriptive statistics were calculated to describe the overall frequency of outpatient facilities prescribing LAIAPs and differences in the specific LAIAPs prescribed. The authors also conducted multivariable analyses to identify facility characteristics associated with likelihood of LAIAP prescribing. RESULTS Across all outpatient mental health care service providers, 30.6% prescribed LAIAPs. Community mental health centers were most likely to prescribe LAIAPs (62.6%), whereas partial hospitalization and day programs were least likely (32.1%). The most used LAIAP was paliperidone palmitate (77.7%), and the least used was olanzapine pamoate (29.6%). Providers with programs specifically for patients with serious mental illness (59.5%) and providers with a dedicated first-episode psychosis program (58.2%) were more likely to prescribe LAIAPs than were providers without such programming. CONCLUSIONS Prescription of LAIAPs is limited at outpatient mental health care service providers in the United States. Expansion of these services and diversification of delivery models are needed to improve LAIAP prescriptions, which are associated with improved patient outcomes across a broad range of measures.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| | - Kristen Chalmers
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| | - Daniel Yohanna
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
| | - Royce Lee
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago (Bunting, Yohanna, Lee); Pritzker School of Medicine, University of Chicago, Chicago (Chalmers)
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Miron AA, Ifteni PI, Teodorescu A, Petric PS. Long-Acting Injectable Antipsychotics (LAIs) Prescribing Trends during the COVID-19 Pandemic in Romania. Healthcare (Basel) 2022; 10:1265. [PMID: 35885792 PMCID: PMC9316377 DOI: 10.3390/healthcare10071265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 01/09/2023] Open
Abstract
Long acting injectable antipsychotics (LAIs) are considered the ideal treatment for schizophrenia, especially for young patients with high rates of non-adherence. In the current COVID-19 pandemic, it has been reported that the administration of LAIs decreased in some areas. The aim of this study was to evaluate the impact of COVID-19 pandemic on the initiation of LAIs. This is a retrospective mirror- image study covering a total period of 24 months: 12 months before and 12 months after the declaration of COVID-19 pandemic on March 11, 2020. During the study period, out of 218 patients admitted with schizophrenia, only 15 (1.3%) received LAIs at discharge. There was a 48.3% reduction in LAIs initiation compared to the pre-pandemic period (29 LAIs initiations in 2019 from 224 admissions). Despite the 27% reduction in the total number of admissions (1500 in 2019 vs. 1100 in 2020), the number of admissions with schizophrenia remained almost the same (224 in 2019 vs. 218 in 2020). COVID-19 pandemic brought an important challenge in the treatment of patients with schizophrenia, especially in the initiation of LAIs. This could have an important impact on the relapse rate in the next period.
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Affiliation(s)
- Ana A. Miron
- Faculty of Medicine, Transilvania University of Braşov, 500036 Brașov, Romania; (P.I.I.); (A.T.); (P.S.P.)
- Spitalul Clinic de Psihiatrie și Neurologie Brașov, 500123 Brașov, Romania
| | - Petru I. Ifteni
- Faculty of Medicine, Transilvania University of Braşov, 500036 Brașov, Romania; (P.I.I.); (A.T.); (P.S.P.)
- Spitalul Clinic de Psihiatrie și Neurologie Brașov, 500123 Brașov, Romania
| | - Andreea Teodorescu
- Faculty of Medicine, Transilvania University of Braşov, 500036 Brașov, Romania; (P.I.I.); (A.T.); (P.S.P.)
- Spitalul Clinic de Psihiatrie și Neurologie Brașov, 500123 Brașov, Romania
| | - Paula S. Petric
- Faculty of Medicine, Transilvania University of Braşov, 500036 Brașov, Romania; (P.I.I.); (A.T.); (P.S.P.)
- Spitalul Clinic de Psihiatrie și Neurologie Brașov, 500123 Brașov, Romania
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5
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Lewis L, Rodgers J. Development and Evaluation of a Web-Based Educational Toolkit on the Knowledge, Attitudes, and Practices of Psychiatric Prescribers Regarding Long-Acting Injectable Antipsychotics. J Am Psychiatr Nurses Assoc 2022; 28:117-127. [PMID: 35176886 DOI: 10.1177/10783903221075651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) are unique and effective pharmacological treatment options for schizophrenia that are underutilized in clinical practice. Research surrounding prescriber barriers to the underuse of LAIs are limited to a few seminal studies which identified psychiatric prescriber barriers to the use of LAIs as knowledge deficits, uninformed attitudes, and poor prescribing practices. There is a gap in the literature regarding effective educational interventions to target the identified psychiatric prescriber barriers to the use of LAIs. AIMS The study aimed to develop a web-based educational toolkit that would positively affect the knowledge, attitudes, and practices of psychiatric prescribers regarding LAIs. METHODS A one-group, before and after design with a convenience, purposive sample of 17 psychiatric prescribers to assess the knowledge, attitudes, and practices (KAP) using a 20-item KAP questionnaire before and after a presentation of a web-based educational toolkit about LAIs was chosen. RESULTS The web-based educational toolkit slightly improved the total and three subscales KAP scores of psychiatric prescribers. However, only the difference in total KAP scores was found to be statistically significant. CONCLUSIONS The developed and evaluated web-based educational toolkit could provide a foundation for positive change to psychiatric prescribers' KAP regarding LAIs.
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Affiliation(s)
- Lisa Lewis
- Lisa Lewis, DNP, CRNP, PMHNP-BC, CARN-AP, Wernersville, PA, USA
| | - Jill Rodgers
- Jill Rodgers, DNP, CRNP, FNP-BC, PMHNP-BC, Edinboro University, Edinboro, PA, USA
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6
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Zhu J, Chen Y, Lu W, Huang Q, Li B, Xu Y, Xi R, Jin L. Attitudes and Willingness to Accept Long-Acting Injections for Patients With Schizophrenia in Beijing: A Cross-Sectional Investigation Based on Samples From the Communities. Front Public Health 2021; 9:770276. [PMID: 34900914 PMCID: PMC8655677 DOI: 10.3389/fpubh.2021.770276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Schizophrenia has brought a serious disease burden to China. Under the background that community rehabilitation has become the mainstream treatment model, the long-acting injection (LAI) can better prevent recurrence. Some districts in Beijing have also issued policies. This article aims to find out patient's current attitudes toward LAI and provide policy suggestions. Methods: Some patients with schizophrenia in the communities are selected, while the survey format is face-to-face conversation. The content of the self-made questionnaire includes patients' willingness and reasons for accepting LAI treatment. Descriptive statistics, t-test and F-test are used to process the data from questionnaire surveys. Results: About 10% of respondents have had experience using LAI and the current utilization rate is 2.4%. Respondents' willingness to accept LAI is generally low (only 18.1% are willing). The main reason for willingness is no need to take medication every day, while the main reasons for unwillingness are high cost, fear of injection and lack of understanding. Conclusion: Beijing community patients are not very optimistic about LAI's cognition and willingness. Medication habits play an important role in their medication selection decisions. Intervention such as educate clinicians and patients about LAI and provide free injections to patients can be imposed. The promotion of LAI still has a long way to go.
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Affiliation(s)
- Junli Zhu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Wei Lu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Qingzhi Huang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Bin Li
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Ying Xu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Rui Xi
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Lefan Jin
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
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Jin L, Chen Y, Zhu J, Huang Q, Li B, Xu Y, Xi R, Lu W. The Willingness of Community Psychiatric Management Physicians to Preferentially Recommend Long-Acting Injections in Beijing. Front Public Health 2021; 9:779563. [PMID: 34869192 PMCID: PMC8639574 DOI: 10.3389/fpubh.2021.779563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Severe mental disorders (SMD) impose a heavy burden on individuals, society, and the country. Under the background of deinstitutionalization, more and more patients return to the community, and the community psychiatric management physicians (CPMP) play an essential role in this process. Long-acting injection (LAI) is an important way to improve compliance and reduce re-hospitalization. Some districts in Beijing have implemented the policy of free LAI. This article aims to find out the willingness of CPMP to preferentially recommend LAI and provide suggestions for follow-up promotion. Methods: All CPMP in 16 districts of Beijing were surveyed. A self-made electronic questionnaire was used to investigate the willingness to recommend LAI in priority. Descriptive statistics, Chi-square test, and logistic regression were used to analyze the data. Results: The willingness of CPMP to preferentially recommend LAI is up to 80%. Participants aged 40–49, female, with higher self-evaluation of psychiatric management knowledge, managing patients who have used LAI in the past, and working in communities with the free LAI policy have higher willingness to recommend LAI in priority. Conclusion: CPMP in Beijing have a positive attitude toward LAI, and most of them have the willingness to recommend LAI to the patients in priority. The recommendation willingness is the basis of prescription decision-making. Therefore, the coverage of free LAI policy should be further expanded in the future to improve the recommendation willingness and thus improve the injection rate of LAI.
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Affiliation(s)
- Lefan Jin
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Junli Zhu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Qingzhi Huang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Bin Li
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Ying Xu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Rui Xi
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Wei Lu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
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de Filippis R, De Fazio P, Gaetano R, Steardo L, Cedro C, Bruno A, Zoccali RA, Muscatello MRA. Current and emerging long-acting antipsychotics for the treatment of schizophrenia. Expert Opin Drug Saf 2021; 20:771-790. [PMID: 33775184 DOI: 10.1080/14740338.2021.1910674] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: In this review, the authors discuss the role of long-acting injectable antipsychotics (LAIs) for schizophrenia, focusing on the effectiveness and new perspectives introduced by such treatment strategy. Despite their promising pharmacokinetic features and their potential advantages in medication adherence, clinical outcomes, and medical costs, LAIs are not habitually presented as an option for patients, especially in the early phase of schizophrenia.Areas covered: This review explores the panorama of available LAIs for the treatment of schizophrenia, first-episode of psychosis, approved indications, medical costs, medication adherence, side effects, effectiveness and differences between first-generation (FGA)-LAIs and second-generation (SGA)-LAIs.Expert Opinion: LAIs differ in terms of specific indications, approved injection sites, needle size, injection volume, injection interval as well as potential drug-drug interactions, and commonly reported adverse reactions. The approved indications have expanded beyond schizophrenia to include bipolar and schizoaffective disorder. SGA-LAIs are often preferred to FGA-LAIs. FGA-LAIs although are less chosen in new patients due to the induction of cognitive and extrapyramidal side effects, even if, on the other hand, many SGA-LAIs are burden by hyperprolactinemia and weight gain. After a review of the available evidence, insight is provided into the potential and current therapeutic opportunities offered by LAI antipsychotic formulations.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Clemente Cedro
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Antonio Bruno
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Rocco Antonio Zoccali
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Maria Rosaria Anna Muscatello
- Psychiatry Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Predictors of discontinuation and hospitalization during long-acting injectable antipsychotic treatment in patients with schizophrenia spectrum disorder. Int Clin Psychopharmacol 2021; 36:89-96. [PMID: 33512962 DOI: 10.1097/yic.0000000000000348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate discontinuation and hospitalization rates in patients with schizophrenia spectrum disorder who were treated with long-acting injectable (LAI) antipsychotics. We recorded clinical data about the period before the LAI treatment, when LAI treatment was initiated, and during the LAI treatment. Variables related to early (<8 weeks) and other LAI discontinuations and hospitalization were analyzed. Out of 452 patients, 14.4% of them discontinued their LAI treatment before 8 weeks, another 24.8% of the patients stopped their LAI by themselves later. Early discontinuers were younger, had shorter duration of illness, and less educated. Sixty-two (27.2%) of the patients were hospitalized under LAI treatment and 40% of the hospitalizations occurred in initial 6 months. Rate of hospitalization was 36.1% in the group who discontinued LAI after 8 weeks. In logistic regression analysis, younger age, history of combined antipsychotic treatment, number of hospitalizations before LAI, use of LAI for less than 6 months and alcohol abuse under LAI treatment were found related to hospitalization. Our findings suggested that discontinuation and hospitalization are still common among the patients who were treated with LAI antipsychotics.
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10
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Fiore G, Bertani DE, Marchi M, Cardoso G, Galeazzi GM. Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies. JORNAL BRASILEIRO DE PSIQUIATRIA 2021. [DOI: 10.1590/0047-2085000000311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication.
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Persistent Barriers to the Use of Long-Acting Injectable Antipsychotics for the Treatment of Schizophrenia. J Clin Psychopharmacol 2021; 40:346-349. [PMID: 32639287 DOI: 10.1097/jcp.0000000000001225] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND One of the major challenges in the treatment of schizophrenia is nonadherence, defined as the failure to take medications as prescribed. Nonadherence is a strong predictor of symptom relapse, hospital readmission, and poorer long-term outcome. Although long-acting injectable antipsychotics (LAIs) have been found to be superior to their oral analogs at reducing relapse in large-scale meta-analyses, their prevalence seldom exceeds 30% even in populations with a history of nonadherence. We review multiple barriers to the use of LAI utilization and suggest strategies to address them. METHODS/PROCEDURES We searched for the following terms: long-acting injectable/depot antipsychotics, schizophrenia, barriers, and attitude/perception in both the PubMed search index and Google scholar from 1995 to 2018. A total of 329 studies were selected, of which data from 13 were reviewed for this article. Only peer-reviewed studies, randomized controlled trials, systematic reviews, and meta-analyses that describe barriers to using LAIs were included. FINDINGS/RESULTS Several barriers to using LAIs were identified. These are organized into 3 overarching categories: those related to the clinician; those related to the patient; and systems barriers. Clinician factors include the perception of LAIs as coercive, fears of not being able to control the dose, as well as current practice patterns and guidelines. Patient factors include perception of the injection as painful or intrusive, general lack of knowledge, and a sense of coerciveness. For each identified barrier, we propose potential solutions. IMPLICATIONS/CONCLUSIONS We identified multiple barriers to using LAIs in patients with schizophrenia. Specific strategies are suggested for overcoming each of these barriers.
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Roy MA, Olivier D, Cambon A. De Kraepelin à McGorry : vision scientifique et récit expérientiel autour d’un changement de paradigme majeur. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088177ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Béchard L, Corbeil O, Malenfant E, Lehoux C, Stip E, Roy MA, Demers MF. Une approche de la psychopharmacologie des premiers épisodes psychotiques axée sur le rétablissement. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088180ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Philbin MM, Parish C, Bergen S, Kerrigan D, Kinnard EN, Reed SE, Cohen MH, Sosanya O, Sheth AN, Adimora AA, Cocohoba J, Goparaju L, Golub ET, Fischl M, Alcaide ML, Metsch LR. A Qualitative Exploration of Women's Interest in Long-Acting Injectable Antiretroviral Therapy Across Six Cities in the Women's Interagency HIV Study: Intersections with Current and Past Injectable Medication and Substance Use. AIDS Patient Care STDS 2021; 35:23-30. [PMID: 33400587 PMCID: PMC7826427 DOI: 10.1089/apc.2020.0164] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Medications for antiretroviral therapy (ART) and preexposure prophylaxis (PrEP) are currently daily pill regimens, which pose barriers to long-term adherence. Long-acting injectable (LAI) modalities have been developed for ART and PrEP, but minimal LAI-focused research has occurred among women. Thus, little is known about how women's history of injection for medical or nonmedical purposes may influence their interest in LAI. We conducted 89 in-depth interviews at 6 sites (New York, NY; Chicago, IL; San Francisco, CA; Atlanta, GA; Chapel Hill, NC; Washington, DC) of the Women's Interagency HIV study. Interviews occurred with women living with HIV (n = 59) and HIV-negative women (n = 30) from November 2017 to October 2018. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Women's prior experiences with injections occurred primarily through substance use, physical comorbidities, birth control, or flu vaccines. Four primary categories of women emerged; those who (1) received episodic injections and had few LAI-related concerns; (2) required frequent injections and would refuse additional injections; (3) had a history of injection drug use, of whom some feared LAI might trigger a recurrence, while others had few LAI-related concerns; and (4) were currently injecting drugs and had few LAI-related concerns. Most women with a history of injectable medication would prefer LAI, but those with other frequent injections and history of injection drug use might not. Future research needs to address injection-related concerns, and develop patient-centered approaches to help providers best identify which women could benefit from LAI use.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Carrigan Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sadie Bergen
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, District of Columbia, USA
| | - Elizabeth N. Kinnard
- Division of Epidemiology, UC Berkeley School of Public Health, Berkeley, California, USA
| | - Sarah E. Reed
- Teachers College, Columbia University, New York, New York, USA
| | - Mardge H. Cohen
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Oluwakemi Sosanya
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Anandi N. Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California at San Francisco School of Pharmacy, San Francisco, California, USA
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Margaret Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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Lambrinou E, Kyriakou M, Lakatamitou I, Angus N, Khatib R, Vellone E, Barrowcliff A, Hansen TB, Lee GA. An integrative review on facilitators and barriers in delivering and managing injectable therapies in chronic conditions: A part of the ACNAP project 'injectable medicines among patients with cardiovascular conditions'. Eur J Cardiovasc Nurs 2020; 19:663-680. [PMID: 32672477 DOI: 10.1177/1474515120939007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although preventive health and therapeutics have benefited from advances in drug development and device innovation, translating these evidence-based treatments into real-world practice remains challenging. AIM The current integrative review aims to identify facilitators and barriers and perceptions in delivering and managing injectable therapies from patient perspectives. METHODS An integrative review was conducted in the databases of PubMed, CINAHL, PsycINFO and Cochrane. Keywords were used "Injectable therapy", "IV therapy", "SC therapy", "long term injectable therapies", "self-administered injectable therapy", "patients", "caregivers", "family", "carers", "facilitators", "barriers", "perspectives", "needs", "expectations", "chronic disease", "cardiovascular disease" linked with the words "OR" and "AND". The search was limited from January 2000 to July 2019. Inclusion and exclusion criteria were used. RESULTS Twenty studies were identified from the literature search. Studies followed qualitative, quantitative methodology and mixed methods. Facilitators included: health improvement, prevention of disease complications, taking control of their disease, effectiveness of the medication and convenience in management. Barriers included: fear of needles, insulin will cause harm, poor perception of the benefits of injectable therapies on their quality of life, inconvenience in self-management, social stigma, impact on daily living, financial barriers, lack of education. Perceptions included: 'treatment of last resort', 'life becomes less flexible', 'injectables were punishment/restriction', 'personal failure of self-management'. CONCLUSION Evidence shows how to create effective communication and shared decision-making relationships to provide best possible care to patients who need injectable therapy and support for self-management. Future research might help guide response to the fears and barriers of the patients using patients' perspectives.
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Affiliation(s)
- Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus
| | | | - Ioanna Lakatamitou
- Intensive Care Unit, American Medical Center/American Heart Institute, Cyprus
| | - Neil Angus
- Department of Nursing & Midwifery, University of the Highlands and Islands, UK
| | - Rani Khatib
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, UK.,Cardiology Department, Leeds Teaching Hospitals NHS, UK.,Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, UK
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Abigail Barrowcliff
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, UK
| | - Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.,University of Southern Denmark, Department of Regional Health Research, Odense, Denmark
| | - Geraldine A Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Robinson DG, Subramaniam A, Fearis PJ, Shi R, Walsh M, Hanna LA, Kane JM. Focused Ethnographic Examination of Barriers to Use of Long-Acting Injectable Antipsychotics. Psychiatr Serv 2020; 71:337-342. [PMID: 31847736 DOI: 10.1176/appi.ps.201900236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors designed this project to identify barriers to using long-acting formulations of antipsychotics. METHODS The authors used a focused ethnographic approach. Patients, psychiatrists, nurses, therapists and administrators were interviewed about barriers to use of long-acting injectable (LAI) antipsychotics at six facilities in New York State, as were representatives from insurance firms, a pharmaceutical company, and a national professional organization. Interviews were conducted and analyzed by a central team not affiliated with the institutions. RESULTS Interviews were obtained with 23 patients, 16 psychiatrists, three nurses, 23 therapists, 14 administrators, four insurers, one representative from a pharmaceutical industry, and one representative from a national organization. Major barriers identified from the interviews included restricting discussions about LAI medication to only patients with nonadherence or repeated hospitalizations; inadequate education efforts with patients about LAI antipsychotics; inadequate support for patients making medication decisions; lack of communication within the treatment team about issues relevant to use of LAI formulations by patients; therapists' limited knowledge about LAI antipsychotics, which restricted their role in supporting patients making treatment decisions; psychiatrist concerns about the pharmacologic properties of LAI formulations; lack of clinic infrastructure to support LAI prescriptions; and payer concerns about whether the immediate costs of LAI administration would translate into later potential cost benefits. CONCLUSIONS Effective shared decision making about use of LAI antipsychotics requires that patients receive accurate information and support for their decision making. The training needs and administrative support requirements of all team members should be considered to provide patients with the information and support required.
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Affiliation(s)
- Delbert G Robinson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Anant Subramaniam
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Paul J Fearis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Richard Shi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Megan Walsh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - Lauren A Hanna
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
| | - John M Kane
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna)
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Berna F, Göritz AS, Behr G, Moritz S. Pill or needle? Determinants of the preference for long-acting injection over oral treatment in people facing chronic illness. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109798. [PMID: 31682893 DOI: 10.1016/j.pnpbp.2019.109798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
Although long-acting injection (LAI) is presented as first line treatment option for patients with psychosis, negative attitudes toward this galenic negatively impact the selection of this treatment option. However, these negative attitudes may not be confined to patients but also observed in the general population. A web-based study on 1807 participants was conducted during which participants imagined that they had a particular chronic illness based on clinical vignettes (mental illnesses: schizophrenia, depression; somatic illnesses: multiple sclerosis, rheumatoid arthritis). The frequency of relapse and the intensity of symptoms were experimentally manipulated in the vignettes. Participants rated their subjective distress associated with each vignette, their belief in the effectiveness of treatment, and their treatment preference regarding medication. We examined under which conditions LAI was preferred over pills. Statistical analyses were performed using Bayesian methods. Results showed that participants preferred LAI over pills in 40.5% to 50.8% of cases. LAI was more preferred for illnesses with low frequency of relapse, low subjective distress, and for somatic than for mental illnesses. The perceived advantage for LAI over pills and the belief about the better efficiency of LAI were the main factors that drove the preference for LAI. Keeping in mind some advantages of LAI, the public negative representations of injections might partially influence patients' prejudices against LAI. These attitudes should be named and discussed with the patients when LAI seems to represent a relevant therapeutic option.
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Affiliation(s)
- Fabrice Berna
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Inserm U1114, Strasbourg, France; Fondation FondaMental, Créteil, France.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany.
| | - Guillaume Behr
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Inserm U1114, Strasbourg, France.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
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Fleming D, Raynsford J, Hosalli P. Reducing long acting antipsychotic injection dosage frequency: A pilot study in a community mental health team. J Ment Health 2020; 30:129-133. [PMID: 31984826 DOI: 10.1080/09638237.2020.1714003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antipsychotic long acting injections (LAI) allow a range of dosage intervals to be administered. Short intervals can be inconvenient for patients and staff. There are few clinical reasons for using them yet this is common practice. AIMS This study aimed to examine the feasibility of reducing LAI frequency with service user consent. METHODS The study took place in a community mental health team in the north of England. A specialist mental health pharmacist reviewed records of all service users on LAI and drew up an action plan. Each service user then met with the consultant psychiatrist for medication review. RESULT Nineteen out of thirty service users on LAI had intervals less than the maximum licensed. The frequency was reduced in eight cases. After 6 months follow-up, there was no deterioration in symptoms. In nine cases, antipsychotic doses were also reduced as a result of the review. CONCLUSION Where a service user is prescribed a LAI with a short dosage interval consideration should be given to increase the interval. This can free up service user and staff time. A medication focused review can also lead to other benefits such as dosage reduction.
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Affiliation(s)
- D Fleming
- Pharmacy Department, Leeds and York Partnership Foundation Trust, West Yorkshire, UK
| | - J Raynsford
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - P Hosalli
- Leeds and York Partnership Foundation Trust, West Yorkshire, UK
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Grover S, Sahoo S, Bn S, Malhotra N, Dua D, Avasthi A. Attitude and perceptions of patients towards long acting depot injections (LAIs). Asian J Psychiatr 2019; 44:200-208. [PMID: 31419737 DOI: 10.1016/j.ajp.2019.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the well-established efficacy of the long acting depot injectable (LAIs) antipsychotics, these are significantly underused and underutilized by the mental health professionals, with a belief that patients will not accept the same. AIMS & OBJECTIVES To explore the acceptability and perception of patients towards various psychiatric treatments, with specific focus on LAIs. Additionally the study aimed to compare the acceptability of various types of treatments including LAIs between patients with severe mental disorders (Psychotic disorders and Bipolar disorder) and those with Common mental disorders (Anxiety, neurotic and depressive disorders). METHODOLOGY A self-designed semi-structured questionnaire was used to evaluate the preferred treatment options of all the new patients attending the psychiatry outpatient clinic of a tertiary care hospital. Depending on the response, they were further probed for the reasons for accepting or rejecting the LAIs. RESULTS 2659 patients were interviewed who were divided into two groups (Group I - 321 subjects with psychotic disorders and 120 subjects with bipolar affective disorder (BPAD) and Group II - 2218 subjects with neurotic, stress-related and unipolar depressive disorders). More than three-fourth (78.8%) of the participants in the whole study sample opted for tablets only as their first preferred choice and injectables were opted by about 5% of the participants only, with no significant difference between the 2 groups. After being explained about LAIs, one fourth of the participants (24.9%) reported that they may consider LAIs, without any significant difference between the 2 groups. Among those who refused to take LAIs even after explanation, the commonly reported reasons were difficulty in visiting hospital frequently for the injectables (41.69%), injectables being painful (19.41%), fear of injections (13.96%), no need to take LAIs (12.45%) and preference to take some other types of medicines (8.52%). CONCLUSIONS Considering the fact that LAIs are highly underused in patients with severe mental disorders and there is lack of awareness about LAIs among patients with severe mental disorders, the present study findings suggest that there is reasonable level of acceptance of LAIs among patients with severe mental disorders when explained about the same.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subodh Bn
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Nidhi Malhotra
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, Sector-32, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Mustafa S, Bougie J, Miguelez M, Clerzius G, Rampakakis E, Proulx J, Malla A. Real-life assessment of aripiprazole monthly (Abilify Maintena) in schizophrenia: a Canadian naturalistic non-interventional prospective cohort study. BMC Psychiatry 2019; 19:114. [PMID: 30991969 PMCID: PMC6469112 DOI: 10.1186/s12888-019-2103-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/04/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With previously established efficacy of aripiprazole once-monthly injectable formulation (AOM) in pre-registration randomized controlled trials, the current study was designed to evaluate its effectiveness in patients treated for schizophrenia in regular clinical settings in Canada. METHODS Following their clinicians' decision to prescribe AOM, 193 patients with a diagnosis of schizophrenia, were recruited from 17 Canadian community or hospital-based settings. The primary outcome of global functioning was assessed with the Global Assessment of Functioning Scale (GAF) at 3-month intervals for 1 year. Secondary outcomes (social and occupational functioning and illness severity) and adverse drug reactions (ADR) were also assessed. RESULTS A majority of the 169 evaluable patients were within the first 5 years of diagnosis (early phase). A linear mixed model analysis showed a significant main effect of time (Type III test p < 0.001) after adjusting for baseline GAF score, with a change in mean GAF scores from 49 at baseline to 61 at 12 months. No differences between early vs late phase were observed. Results on secondary outcome measures of function (Social and Occupational Functioning Scale) and illness severity (Clinical Global Impression-Severity Scale and Brief Psychiatric Rating Scale) were similar. Serious ADRs were observed in 29 (14.6%) patients and akathisia in 18 (9.1%) patients. At month-12, significant (≥7%) weight gain was observed in 25.7% (n = 27/105) of patients. CONCLUSIONS Treatment with AOM is effective in improving symptoms and functioning in schizophrenia patients treated in regular clinical settings. Akathisia was infrequent while one quarter of patients gained clinically significant weight. TRIAL REGISTRATION Unique identifier: NCT02131415 . First posted: 06 May 2014.
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Affiliation(s)
- Sally Mustafa
- Douglas Mental Health University Institute, Montreal, Quebec Canada
| | | | - Maia Miguelez
- Otsuka Canada Pharmaceutical Inc, Montreal, Quebec Canada
| | | | | | - Jean Proulx
- Lundbeck Canada Inc, Montreal, Quebec Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, Montreal, Quebec Canada
- Department of Psychiatry, McGill University, Montreal, Quebec Canada
- ACCESS-Canada, 6625, boulevard LaSalle, Montreal, QC H4H 1R3 Canada
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Lai JK, Margolese HC. A qualitative study of patient experience when switching from paliperidone palmitate once monthly (PP1M) to paliperidone palmitate three monthly (PP3M) long-acting injectable antipsychotic. Schizophr Res 2019; 204:443-444. [PMID: 30241989 DOI: 10.1016/j.schres.2018.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/21/2018] [Accepted: 09/15/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Jonathan K Lai
- Department of Psychiatry, McGill University Health Centre, Allan Memorial Institute, 1025 Pine Ave. W, Montreal, Quebec H3A 1A1, Canada..
| | - Howard C Margolese
- Department of Psychiatry, McGill University Health Centre, Allan Memorial Institute, 1025 Pine Ave. W, Montreal, Quebec H3A 1A1, Canada
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Di Lorenzo R, Ferri P, Cameli M, Rovesti S, Piemonte C. Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting. Neuropsychiatr Dis Treat 2019; 15:183-198. [PMID: 30662264 PMCID: PMC6328290 DOI: 10.2147/ndt.s189245] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations. PURPOSE To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM). METHODS We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed. RESULTS The three LAI groups differed significantly only for "need for economic support from social service" (more frequent in the Hal-D group) and "schizoaffective disorder" (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months' treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P<0.001) and overlapping clinical and functioning improvement-scale scores (P<0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar for number and severity, were reported in the three LAI groups. CONCLUSION Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia's clinical course and its economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy,
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Cameli
- Private Accredited Psychiatric Hospital, Villa degli Ulivi, Caserta, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Piemonte
- Private Accredited Psychiatric Hospital, Villa Igea, Modena, Italy
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Chiu LL, Liu CH, Chu CL, Lin HL, Lii SC. Patients' experiences of long-acting injectable antipsychotics: a qualitative study. Neuropsychiatr Dis Treat 2019; 15:1797-1804. [PMID: 31308672 PMCID: PMC6613361 DOI: 10.2147/ndt.s206154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In this study, we applied a qualitative approach to explore patients' subjective experiences of long-acting injectable antipsychotics (LAIs). METHODS Patients undergoing psychiatric treatment from the chronic ward or outpatient department of a medical center in northern Taiwan who had experience with LAI treatment were enrolled. Information was obtained through semi-structured in-depth interviews. The interviews were audio-recorded and then translated verbatim, and the data were collected and analyzed concurrently to develop major themes and categories. RESULT In total, 14 participants (8 female) were interviewed. In a bio-psycho-social model, the participants used LAIs as a method to become "normal," in order to achieve a balance between the "effects" and "side effects" that may influence their daily lives. Their past experiences constructed their concepts about and expectations regarding LAIs, and their relationships with their family members and co-workers also modeled their experiences. CONCLUSION In our study, we sought to understand the experience of LAI in the daily life context of the patients. We attempted to use a bio-psycho-social model to evaluate the subjective experience of the patients; an improved understanding can help mental health specialists gain a closer insight into patient experience.
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Affiliation(s)
- Lin-Ling Chiu
- School of Medicine, Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Child Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Lin Chu
- Department of Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
| | - Huang-Li Lin
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Chung Lii
- Humanistic & Social Medicine Division, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Ostuzzi G, Mazzi MA, Terlizzi S, Bertolini F, Aguglia A, Bartoli F, Bortolaso P, Callegari C, Caroleo M, Carrà G, Corbo M, D’Agostino A, Gastaldon C, Lucii C, Magliocco F, Martinotti G, Nosé M, Ostinelli EG, Papola D, Piccinelli MP, Piccoli A, Purgato M, Tabacchi T, Turrini G, Ruggeri M, Barbui C. Factors associated with first- versus second-generation long-acting antipsychotics prescribed under ordinary clinical practice in Italy. PLoS One 2018; 13:e0201371. [PMID: 30071042 PMCID: PMC6072022 DOI: 10.1371/journal.pone.0201371] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
Background For many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy. Methods The STAR Network “Depot” Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed. Results Of the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past. Discussion LAIs’ prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAIs.
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Affiliation(s)
- Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- * E-mail:
| | - Maria Angela Mazzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Samira Terlizzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Bertolini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, IRCCS "Policlinico San Martino" Hospital, University of Genoa, Genoa, Italy
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Paola Bortolaso
- Università degli Studi dell'Insubria, Dipartimento di Salute Mentale e Dipendenze-ASST Settelaghi Varese, Varese, Italy
| | - Camilla Callegari
- Università degli Studi dell'Insubria, Dipartimento di Salute Mentale e Dipendenze-ASST Settelaghi Varese, Varese, Italy
| | - Mariarita Caroleo
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Division of Psychiatry, University College of London, London, UK
| | - Mariangela Corbo
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Armando D’Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health, San Paolo Hospital, Milan, Italy
| | - Chiara Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Claudio Lucii
- Mental Health Department, USL Toscana sudest-Siena, Siena, Italy
| | - Fabio Magliocco
- Department of Health Sciences, Psychiatric Unit, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Michela Nosé
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Edoardo Giuseppe Ostinelli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health, San Paolo Hospital, Milan, Italy
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marco Piero Piccinelli
- Università degli Studi dell'Insubria, Dipartimento di Salute Mentale e Dipendenze-ASST Settelaghi Varese, Varese, Italy
| | - Alberto Piccoli
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Tommaso Tabacchi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Pietrini F, D’Anna G, Tatini L, Talamba GA, Andrisano C, Calderani E, Manetti M, Rossi Prodi P, Ricca V, Ballerini A. Changes in attitude towards LAI antipsychotic maintenance treatment: A two-year follow-up study. Eur Psychiatry 2018; 53:58-65. [DOI: 10.1016/j.eurpsy.2018.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/31/2022] Open
Abstract
AbstractBackground:To present real-world evidence on the effects of switching from oral to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) in a sample of clinically stable patients with schizophrenia, with regard to subjective experience of treatment, attitude towards drug and quality of life.Methods:50 clinically stable adult schizophrenic outpatients were recruited. At the time of enrolment (T0), all patients were under a stabilized therapy with a single oral second-generation antipsychotic (SGA) and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. 43 patients completed the 24-month prospective, longitudinal, open-label, observational study. Participants were assessed at baseline (T0), after 12 (T1) and 24 months (T2), using psychometric scales (PANSS, YMRS and MDRS) and patient-reported outcome measures (SWN-K, DAI-10 and SF-36).Results:The switch to LAI-AMT was associated with a significant clinical improvement at T1 and T2 compared to baseline (T0). All of the psychometric indexes, as well as patients’ subjective experience of treatment (SWN-K), and quality of life (SF-36) showed a significant improvement after one year of LAI-AMT, with stable results after two years. Patients’ attitude towards drug (DAI-10) increased throughout the follow-up period, with a further improvement during the second year.Conclusions:The switch to LAI-AMT may help to address the subjective core of an optimal recovery in stabilized schizophrenic patients. A sustained improvement in patients’ attitude towards drug may help to achieve patient’s compliance. The size of this study needs to be expanded to produce more solid and generalizable results.
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Salzmann-Erikson M, Sjödin M. A narrative meta-synthesis of how people with schizophrenia experience facilitators and barriers in using antipsychotic medication: Implications for healthcare professionals. Int J Nurs Stud 2018; 85:7-18. [PMID: 29803018 DOI: 10.1016/j.ijnurstu.2018.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is recognized that people who are diagnosed with schizophrenia often do not fully adhere with their antipsychotic prescription. The vast majority of previous research on the topic of medical adherence is limited to quantitative research methods, and in particular, to determining correlations. OBJECTIVES The present review was designed to describe how people who are diagnosed with schizophrenia experience and narrate pharmacological treatment with antipsychotic medication. DESIGN A narrative meta-synthesis. DATA SOURCES/REVIEW METHOD A search was conducted in three databases, PubMed, CINAHL and PsycINFO, to identify qualitative original research. Nine articles met the criteria for inclusion and were subjected to a qualitative interpretive meta-synthesis. RESULTS The findings showed that patients were uninformed about medication but valued talks about medication with professionals. The findings also demonstrated that patients are motivated to take medication in order to gain stability in their life and to be able to participate in life activities and in relationships. Good support, both from relatives and professionals, also motivates them to continue taking medication. The obstacles were side-effects, pressure and compulsion, and rigid organizations. CONCLUSIONS We advise professionals to adopt a person-centered approach to healthcare when encountering these patients and to transform the language used to describe patients from terms denoting compliance and adherence to terms denoting cooperation and alliance. Labeling patients as compliant or non-adherent may risk fortifying preconception of patients as static beings and obscure the patients' individual recovery process.
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Affiliation(s)
- Martin Salzmann-Erikson
- University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, SE-801 76 Gävle, Sweden.
| | - Marie Sjödin
- Northern Stockholm Psychiatry, Section for Affective Disorders, Ward 53, Inpatient care unit for patients with bipolar disorder, SE-112 81 Stockholm, Sweden.
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Pedley R, McWilliams C, Lovell K, Brooks H, Rushton K, Drake RJ, Rumbold B, Bell V, Bee P. Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing. BJPsych Open 2018; 4:5-14. [PMID: 29388908 PMCID: PMC6020265 DOI: 10.1192/bjo.2017.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/26/2017] [Accepted: 11/09/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication. Aims To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions. METHOD Systematic thematic synthesis. RESULTS Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes. CONCLUSIONS Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement. Declaration of interest None.
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Affiliation(s)
- Rebecca Pedley
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Room 6.306 Jean McFarlane Building,
Oxford Road, Manchester, M13
9PL
| | - Caitlin McWilliams
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Karina Lovell
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Helen Brooks
- Department of Psychological Sciences,
Institute of Psychology, Health and Society,
University of Liverpool, Liverpool,
L69 3BX
| | - Kelly Rushton
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Richard J. Drake
- Division of Psychology and Mental Health,
School of Health Sciences, Faculty of
Biology, Medicine and Health, The University
of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Barnaby Rumbold
- Millbrook Independent Hospital,
Wythenshawe, Manchester, M23
2RX
| | - Vicky Bell
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
| | - Penny Bee
- Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of
Biology, Medicine and Health, The
University of Manchester, Manchester Academic Health Science
Centre, Oxford Road, Manchester,
M13 9PL
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Sreeraj VS, Shivakumar V, Rao NP, Venkatasubramanian G. A critical appraisal of long acting injectable antipsychotics: Translating research to clinics. Asian J Psychiatr 2017; 28:57-64. [PMID: 28784398 DOI: 10.1016/j.ajp.2017.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 12/27/2022]
Abstract
Long acting injections (LAI) are an effective alternative mode of administration of antipsychotics, less commonly used in clinical practice. Gap in knowledge base is an important source of attitudinal bias. Current article is focused on reviewing the literature for the principles underlying the choice, initiation, maintenance, switch and termination of an LAI; historical, pharmacological and clinical factors implicating the rationale of using LAI against oral agents and older against newer LAIs. Evidences available in clinical and basic psychopharmacological researches are critically appraised, highlighting the lacunae in our understanding. It is endeavored to open the window for the studies to be carried forward in the future answering critical questions which could lay a stronger base for clinical utility of different LAIs. Thus, this article tries to acquaint clinicians with the translatable knowledge imparted from the research and riposte queries for the researchers to explore in relation to LAI.
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Affiliation(s)
- Vanteemar S Sreeraj
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Venkataram Shivakumar
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Ostuzzi G, Bighelli I, So R, Furukawa TA, Barbui C. Does formulation matter? A systematic review and meta-analysis of oral versus long-acting antipsychotic studies. Schizophr Res 2017; 183:10-21. [PMID: 27866695 DOI: 10.1016/j.schres.2016.11.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 01/07/2023]
Abstract
Recently, many authors highlighted the potential advantages of a broader prescription of long-acting injectable antipsychotics (LAIs) based on various assumptions, including favorable pharmacokinetic features. In this systematic review, data from randomized controlled trials comparing LAIs versus the oral formulation of the same antipsychotic were meta-analyzed in order to ascertain whether the route of administration may be associated with a different efficacy and tolerability profile. Of 21 included studies, 18 contributed to the meta-analysis, providing data for risperidone, olanzapine, aripiprazole, zuclopenthixol, fluphenazine and haloperidol. For all drugs, the number of dropouts for any reason (primary outcome) did not differ between the two formulations, except for a small effect in favor of LAI aripiprazole (2 comparisons; 986 patients; relative risk (RR) 0.78; 95% confidence interval (CI) 0.64 to 0.95). Similarly, no differences emerged in terms of dropouts for adverse events, extrapyramidal symptoms, prolactin increase (except for a small advantage for LAI risperidone), weight gain, non-response rate, relapse rate, and dropouts for inefficacy (except for a small advantage for oral olanzapine). Data on aripiprazole proved to be of high quality according to the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation), therefore we are confident that the effect estimate is close to the true effect. Data on risperidone were of moderate quality, while data on olanzapine, fluphenazine, zuclopenthixol and haloperidol were of low quality. In conclusion, there is no robust evidence to support doctors in choosing LAI instead of oral formulations in order to obtain better tolerability and efficacy.
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Affiliation(s)
- Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
| | - Irene Bighelli
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany.
| | - Ryuhei So
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan; Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Stevens GL, Dawson G, Zummo J. Clinical benefits and impact of early use of long-acting injectable antipsychotics for schizophrenia. Early Interv Psychiatry 2016; 10:365-77. [PMID: 26403538 PMCID: PMC5054869 DOI: 10.1111/eip.12278] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/17/2015] [Indexed: 01/31/2023]
Abstract
AIM Results from clinical trials support the use of oral antipsychotics for treatment of early or first-episode psychosis in patients with schizophrenia. This paper will review literature on the advantages of early initiation of treatment for schizophrenia and the clinical benefits of early use of long-acting injectable antipsychotics (LAIs). METHOD A comprehensive literature review was conducted to identify published literature on the use of LAIs early in the treatment of schizophrenia. RESULTS Although there is a higher response rate to initial antipsychotic treatment for a first-episode of schizophrenia than with subsequent antipsychotic treatment, we have not effectively addressed this issue. Poor adherence to treatment is a primary cause of relapse and rehospitalization in subsequent years and was associated with higher relapse rates resulting in devastating effects and substantial economic burden. The costs of nonadherence were estimated to be $1.48 billion. Thus, a major challenge with the treatment of schizophrenia is changing poor adherence to persistence with antipsychotic therapy. LAIs are known to be at least as effective as oral antipsychotics for treating schizophrenia, and yet are underutilized. Further, LAIs address many of the problems associated with adherence to oral therapy. Recent evidence suggests that LAIs are effective for treating first-episode psychosis and for early initiation of treatment for schizophrenia. CONCLUSION Although consistent antipsychotic treatment represents a critical part of treatment, a person-centred approach to treating schizophrenia is essential for all aspects of care, including establishing and maintaining a therapeutic alliance, strengthening shared decision-making and adherence, and achieving long-lasting recovery.
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Affiliation(s)
- Georgia L Stevens
- Partners in Aging & Long-Term Caregiving, Washington, District of Columbia, USA.
| | - Gail Dawson
- Wholeness Center, Fort Collins, Colorado, USA
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Barriers to the use of long-acting injectable antipsychotics in schizophrenia may be overcome by implementing a variety of strategies. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0345-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Schizophrenia and related disorders remain major disabling conditions, mainly due to antipsychotic treatment resistance and to relapses related to antipsychotic nonadherence. Treatment nonadherence rates are consistently high in long-term patients, but also in first-episode patients with schizophrenia. Long-acting injectable antipsychotics (LAIAs) were mainly developed to improve adherence to treatment and to reduce the rate of relapse and rehospitalization in schizophrenia due to treatment discontinuation. There is favorable clinical evidence, in terms of both efficacy and treatment adherence, that could support higher LAIA prescription rates, especially in patients in early phases of psychotic disorders. Several factors could be hindering wider use of LAIAs, mainly associated with perceptions and attitudes of patients, clinicians, and health managers or policy makers. The main aims of this review are (i) to summarize the existing data on the efficacy and tolerability of LAIAs compared with oral formulations in the management of schizophrenia and related disorders, focusing on the novel, second-generation LAIA options; (ii) to analyze the barriers that exist to the more widespread use of these formulations; and (iii) to discuss possible approaches to overcoming these barriers.
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Pietrini F, Spadafora M, Tatini L, Talamba GA, Andrisano C, Boncompagni G, Manetti M, Ricca V, Ballerini A. LAI versus oral: A case-control study on subjective experience of antipsychotic maintenance treatment. Eur Psychiatry 2016; 37:35-42. [PMID: 27442981 DOI: 10.1016/j.eurpsy.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects. METHODS Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1). RESULTS Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period. CONCLUSIONS Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
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Affiliation(s)
- F Pietrini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy.
| | - M Spadafora
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - L Tatini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - G A Talamba
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - C Andrisano
- Department of biomedical and neuromotor sciences, university of Bologna, Bologna, Italy
| | - G Boncompagni
- Department of mental health and substance abuse, local health trust of Bologna, Bologna, Italy
| | - M Manetti
- Therapeutic psychiatric community, Campo del Vescovo Union, La Spezia, Italy
| | - V Ricca
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - A Ballerini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
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[Advantages and controversies of depot antipsychotics in the treatment of patients with schizophrenia]. DER NERVENARZT 2016; 87:719-23. [PMID: 26597275 DOI: 10.1007/s00115-015-0021-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this article is to give an overview of the advantages and disadvantages of the use of depot antipsychotics in the treatment of schizophrenia. The focus is on efficacy, tolerability, relapse prevention, patient compliance and satisfaction compared to oral administration forms. MATERIAL AND METHODS A literature search was conducted in medical databases. The results of meta-analyses, randomized controlled trials and systematic reviews from the years 1999-2014 were included. RESULTS AND DISCUSSION Depot antipsychotics ensure maintenance of constant blood levels and a continuous medication delivery. The efficacy and tolerability of depot antipsychotics are comparable to oral administration forms. Due to an improved medication compliance a reduction of relapse and hospitalization rates can be achieved. This is a key focus for improving outcomes and reducing costs in the treatment of schizophrenia.
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Abstract
OBJECTIVES To review the published literature on aripiprazole once monthly, a second generation antipsychotic (SGA) recently developed as a long-acting injection (LAI), in the form of a suspension of lyophilized aripiprazole reconstituted with an aqueous diluent, for intramuscular administration. METHODS An electronic database search was conducted using the key words; relevant articles were then hand searched and websites (FDA, EMA, Otsuka, Lundbeck, NIH) reviewed. RESULTS Efficacy has been demonstrated in preventing relapse in a 52 week study versus placebo, and non-inferiority to oral aripiprazole in a 38 week study, as well as in the treatment of hospitalized adult patients with acutely relapsed schizophrenia. Aripiprazole LAI appears cost-effective versus other SGA-LAIs, with improved health-related quality of life and functioning in a head-to-head study with paliperidone LAI. A 6 month (pre and post), mirror-image switch study demonstrated a reduction in hospitalization and associated costs compared with previous antipsychotic treatment. Safety and tolerability are comparable to oral aripiprazole with no new safety signals. CONCLUSIONS Experience with oral aripiprazole and the current availability of the long-acting formulation suggest a potential benefit in a variety of clinical scenarios and therefore consideration as a treatment option in the treatment of schizophrenia.
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Affiliation(s)
- Pierre Chue
- a University of Alberta , Edmonton, Alberta , Canada
| | - James Chue
- b Clinical Trials and Research Program , Edmonton, Alberta , Canada
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Pietrini F, Spadafora M, Talamba GA, Godini L, Lelli L, Arcabasso S, Manetti M, Ballerini A. The effects of switching from oral to LAI antipsychotic treatment on subjective experience of schizophrenic and schizoaffective patients: Preliminary results. Int J Psychiatry Clin Pract 2015; 19:106-13. [PMID: 25410156 DOI: 10.3109/13651501.2014.988268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To present real-world preliminary evidence on the specific effects of switching from oral to long-acting injectable (LAI) antipsychotic treatment on patient's subjective experience and quality of life (QoL) in a sample of clinically stable psychotic subjects. METHODS Twenty-six clinically stable adult schizophrenic and schizoaffective outpatients were recruited. All patients were under a stabilized therapy with a single oral second-generation antipsychotic and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. Two subgroups of patients were created on the basis of the presence/absence of a complete clinical remission at enrollment. Anthropometric (body mass index), psychometric (Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, and Positive And Negative Syndrome Scale), and patient's reported outcome (Subjective Well-Being Under Neuroleptics scale short form, Drug Attitude Inventory short version, and Short Form-36 health survey) data were collected at enrollment (T0) and after 6 months from the treatment switch (T1). RESULTS Significant improvements in psychometric indexes, and patients' subjective experience of treatment and attitudes toward drug (reflecting in an enrichment of patients' health-related QoL) were found both in initial remitters and non-remitters. CONCLUSIONS Our preliminary results suggest that the switch from oral to LAI antipsychotic treatment may help to address the subjective core of an optimal and satisfying recovery of psychotic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
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Affiliation(s)
- Francesco Pietrini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence , Florence , Italy
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Malla A, Tibbo P, Chue P, Levy E, Manchanda R, Teehan M, Williams R, Iyer S, Roy MA. Long-acting injectable antipsychotics: recommendations for clinicians. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:30S-5S. [PMID: 23945065 DOI: 10.1177/088740341305805s05] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A major source of limitation to the real effectiveness of antipsychotics is the high rate of patient nonadherence or, more frequently, partial adherence. Using long-acting injectable (LAI) formulations is likely to reduce the impact of such adherence problems. Conversely, the use of LAIs in Canada remains low relative to many other jurisdictions. Based on effectiveness data from randomized control trials and other, less rigorous, studies, as well as our 2 qualitative studies exploring numerous issues around the use of LAIs, including their low use, we put forward 10 different recommendations for consideration by clinicians. These are also based on the experience of many clinicians and clinician scientists. These recommendations address mostly clinical challenges associated with the use of LAIs. Their application in clinical settings is illustrated in our report through several case examples highlighting the large variation across patients and different phases of illness. It is recommended that LAIs should be considered as a treatment option for psychotic disorders across all phases, including the first 2 to 5 critical years.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec.
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Iyer S, Banks N, Roy MA, Tibbo P, Williams R, Manchanda R, Chue P, Malla A. A qualitative study of experiences with and perceptions regarding long-acting injectable antipsychotics: part II-physician perspectives. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:23S-9S. [PMID: 23945064 DOI: 10.1177/088740341305805s04] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In many countries, including Canada, a small proportion of people with psychotic disorders receive long-acting injectable (LAI) antipsychotics (APs), despite their demonstrated effectiveness and possible advantages for improving adherence rates. Attitudes regarding LAIs among physicians may influence their prescribing practices and thereby contribute to the underuse of LAIs. Here, we report on a qualitative study of perceptions and attitudes toward LAIs among psychiatrists in Canada. METHOD Focus groups were conducted with 24 psychiatrists in 4 Canadian provinces. The focus groups inquired about experiences with and attitudes toward LAI APs. The sessions were audiotaped and transcribed verbatim, and transcripts were coded using a hybrid process of deductive and inductive methods. A brief pre-focus group questionnaire was administered. RESULTS The pre-focus group questionnaires indicated that psychiatrists in our study prescribed the oral formulation of APs most of the time and had limited experience with LAIs. The focus groups yielded 4 main themes: limited knowledge about and experience with LAIs; attitudes toward LAIs (beliefs about negative perceptions of patients regarding LAIs, personal bias against needles, and consensus about some advantages of LAIs); prescribing practices around LAIs (generally seen as a last-resort option for patients with a history of nonadherence); and pragmatic barriers to using LAIs (for example, cost, storage, and staffing). CONCLUSION Several factors may be contributing to the underuse of LAIs and the continuing stigmatized and coercive image of LAIs. Psychiatrists may benefit from better education about LAIs, and from self-examination of their attitudes to LAIs and their prescribing practices.
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Affiliation(s)
- Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, Quebec
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