Characteristics of people on long-acting injectable antipsychotics in Australia: Data from the 2010 National Survey of High Impact Psychosis

2021 ◽  
pp. 000486742110096
Author(s):  
Shuichi Suetani ◽  
Dan Siskind ◽  
Andrea Phillipou ◽  
Anna Waterreus ◽  
Vera A Morgan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
First Generation ◽  
Second Generation ◽  
High Impact ◽  
Community Treatment ◽  
Duration Of Illness ◽  
Second Generation Antipsychotic ◽  
Long Acting ◽  
Treatment Order ◽  
Community Treatment Order

Objective: This study investigates (1) the proportion of people with psychosis who are on long-acting injectable antipsychotics; (2) the difference in the demographic, clinical, substance use and adverse drug reaction profiles of people taking long-acting injectables compared to oral antipsychotics; and (3) the differences in the same profiles of those on first-generation antipsychotic versus second-generation antipsychotic long-acting injectables. Methods: Data were collected as part of the Survey of High Impact Psychosis. For this study, participants with diagnoses of schizophrenia or schizoaffective disorder who were on any antipsychotic medication were included ( N = 1049). Results: Nearly a third (31.5%) of people with psychosis were on long-acting injectables, of whom 49.7% were on first-generation antipsychotic long-acting injectables and 47.9% were on second-generation antipsychotic long-acting injectables. This contrasts with oral antipsychotics where there was a higher utilisation of second-generation antipsychotics (86.3%). Of note, compared to those on the oral formulation, people on long-acting injectables were almost four times more likely to be under a community treatment order. Furthermore, people on long-acting injectables were more likely to have a longer duration of illness, reduced degree of insight, increased cognitive impairment as well as poor personal and social functioning. They also reported more adverse drug reactions. Compared to those on first-generation antipsychotic long-acting injectables, people on SGA long-acting injectables were younger and had had a shorter duration of illness. They were also more likely to experience dizziness and increased weight, but less likely to experience muscle stiffness or tenseness. Conclusion: Long-acting injectable use in Australia is associated with higher rates of community treatment order use, as well as poorer insight, personal and social performance, and greater cognitive impairment. While long-acting injectables may have the potential to improve the prognosis of people with psychosis, a better understanding of the choices behind the utilisation of long-acting injectable treatment in Australia is urgently needed.

Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study

2021 ◽  
pp. 000486742110516
Author(s):  
Mark Taylor ◽  
Dante Dangelo-Kemp ◽  
Dennis Liu ◽  
Steve Kisely ◽  
Simon Graham ◽  
...  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Treatment Persistence ◽  
Persistence Time ◽  
Hazard Ratios ◽  
Second Generation Antipsychotics ◽  
Time In Treatment ◽  
Second Generation Antipsychotic ◽  
Long Acting ◽  
Subsequent Relapse

Objectives: To evaluate the utilisation and persistence of antipsychotics for the treatment of schizophrenia in Australia. Methods: A retrospective study using the Australian Pharmaceutical Benefits Scheme database of a representative 10% sample. All adults with schizophrenia who were dispensed three or more supplies of oral (including clozapine) or long-acting injectable antipsychotics between 1 June 2015 and 31 May 2020 were included. Persistence time in treatment was evaluated using survival analysis and Cox hazard ratios. Results: In all, 26,847 adults with schizophrenia were studied. Oral second-generation antipsychotics were more frequently dispensed than the other antipsychotic groups studied. Median treatment persistence times were 18.3 months for second-generation antipsychotic long-acting injectables, 10.7 months for oral second-generation antipsychotics and were significantly lower for both formulations of first-generation antipsychotics at 5.2 months (long-acting injectables) and 3.7 months (oral). The median persistence time for clozapine was significantly longer than all other antipsychotics groups. Conclusions: Oral second-generation antipsychotics and second-generation antipsychotic long-acting injectables accounted for over 75% and 13% of all antipsychotics in Australia, respectively. Concerns over medication adherence and subsequent relapse have not translated into increased long-acting injectable usage despite their significantly longer persistence. Clozapine, the single most ‘persistent’ antipsychotic, was only used in 9% of people, although up to a third of all cases are likely to be treatment-resistant. Our data suggest clinicians should give consideration to the earlier use of second-generation antipsychotic long-acting injectables and clozapine, to ameliorate prognosis in schizophrenia.

scholarly journals First-generation versus second-generation long-acting injectable antipsychotic drugs and time to relapse

2018 ◽  
Vol 8 (12) ◽  
pp. 333-336 ◽  
Author(s):  
James M. Stone ◽  
Simon Roux ◽  
David Taylor ◽  
Paul D. Morrison
Keyword(s):  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Patient Acceptability ◽  
Inpatient Ward ◽  
Medication Discontinuation ◽  
Kaplan Meier ◽  
The Difference ◽  
Long Acting ◽  
Time To Relapse

Background: The development of long-acting injectable formulations (LAIs) of second-generation antipsychotic drugs (SGAs) has been suggested as having advantage over first-generation antipsychotic (FGA) LAIs. In this study, we investigated the hypothesis that there was a longer time to relapse in patients with schizophrenia started on SGA LAI versus FGA LAI. Methods: Patients with a diagnosis of schizophrenia or schizoaffective disorder who were started on an SGA LAI while on an inpatient ward were identified through searching of the anonymised historical medical records at the South London and Maudsley NHS Foundation Trust. Patients starting FGA LAIs matched for diagnosis, age and date of hospital admission were identified. Time to readmission, discontinuation of LAI or death were identified. Kaplan–Meier plots were generated for each group, and the difference between groups analysed using log-rank methods. Results: There were 157 patients identified in each group. There was no difference in time to readmission, medication discontinuation or death in patients on SGA LAI versus FGA LAI. Conclusions: We found no evidence of advantage in terms of maintaining response in SGA LAI versus FGA LAI. Prescriber choice should be guided by other factors such as side-effect profile, patient acceptability and price.

Compulsory Psychiatric Treatment in the Community

1991 ◽  
Vol 158 (6) ◽  
pp. 792-799 ◽  
Author(s):  
Tom Sensky ◽  
Timothy Hughes ◽  
Steven Hirsch
Keyword(s):  
Psychiatric Treatment ◽  
Treatment Compliance ◽  
Community Treatment ◽  
Control Group ◽  
The Past ◽  
History Of ◽  
Treatment Use ◽  
Reduced Time ◽  
Treatment Order ◽  
Community Treatment Order

Following in-patient psychiatric treatment under Section 3 of the Mental Health Act, some patients have in the past remained on Section after discharge, and subsequently the Section has been renewed while the patient remained ‘on leave’. People treated thus with ‘extended leave’ probably resemble closely those who would be placed on a community treatment order if this were available. A group of these extended-leave patients was compared with a control group, matched for age, sex and diagnosis, selected by consultant psychiatrists as not requiring treatment using a community treatment order. The two groups showed very few differences, but the extended-leave patients more commonly had a history of recent dangerousness and non-compliance with psychiatric treatment. Use of extended leave improved treatment compliance, reduced time spent in hospital, and reduced levels of dangerousness.

scholarly journals Community treatment orders – principles and attitudes

2013 ◽  
Vol 37 (2) ◽  
pp. 58-59 ◽  
Author(s):  
Vimal Kumar Sharma
Keyword(s):  
Community Treatment ◽  
Successful Implementation ◽  
Care Providers ◽  
Community Treatment Orders ◽  
Expected Number ◽  
The Past ◽  
Number Of Patients ◽  
Patient Groups ◽  
Treatment Order ◽  
Community Treatment Order

SummaryThe community treatment order (CTO) was implemented in 2008 as part of the 2007 amendments to the Mental Health Act 1983. Initially, health professionals and patient groups were sceptical about the successful implementation of CTOs. However, as more than the expected number of patients has been subjected to CTOs in the past 3 years in England and Wales, the professionals' views are shifting in favour of CTOs. More needs to be done to improve the approach and attitude of care providers so that CTOs are used in the most appropriate and effective way for the patients.

scholarly journals Comparison of hospitalizations in patients on first generation versus second generation long acting injectable (LAI) antipsychotics

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S283-S283
Author(s):  
Seemab Rasool ◽  
Paster Venan
Keyword(s):  
Drug Abuse ◽  
Observational Study ◽  
First Generation ◽  
Second Generation ◽  
Hospital Admissions ◽  
Paranoid Schizophrenia ◽  
Bipolar Affective Disorder ◽  
Community Treatment ◽  
P Value ◽  
Targeted Interventions

AimsThere is limited data on the comparison of efficacy between first and second antipsychotic LAIs. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics, significantly reduce hospitalizations as compared to conventional depots.Our aim was to compare hospitalizations in patients on first and second generation LAI antipsychotics.MethodA retrospective observational study was done by reviewing the records of all the depot clinics in South Essex, United Kingdom. A list of patients enrolled and receiving LAI antipsychotics was obtained from the 6 depot clinics. Data were collected by going through the electronic records of the patients on the depot clinic lists and taking down the demographics, diagnosis and the hospital admissions. Other variables like comorbid drug abuse were also recorded.ResultAmongst a total of 346 patients 223 (64 %) were males and 123 (36%) were females. Average age was 50.3 (range 21 to 88 years) and 290 (83%) patients were single. An overwhelming majority of patients 299 (87 %) were not in employment. Regarding the diagnosis, the majority, 237 patients were diagnosed with Paranoid Schizophrenia, 49 patients were diagnosed with Schizoaffective disorder, 38 patients were diagnosed with Bipolar affective disorder, 20 patients had a diagnosis of Delusional disorder and only 2 patients had a primary diagnosis of Mental and Behavioral disorders due to substance abuse. Of the total 346 only 17 patients were on a Community treatment Order.Risperidone was the most commonly used second generation LAI at 26%,Aripiprazole in 10% and Paliperidone was used in 5% patients. Olanzapine LAI was only used in 2 patients. Amongst first generation LAIs Zuclopenthixol, Fluclopentixol were both used in 24%, and Haloperidol in 10% patients. 21 % of patients were reported to be actively abusing drugs.65 (32.6%) of the total 200 patients on Ist Generation LAIs had hospital admissions55 (39.8%) of the total 138 patients on 2nd Generation LAIs had hospital admissionsThis difference was not statistically significant (Z test)- P value of 0.082427ConclusionThe results in our observational study are equivocal, both LAIs providing equitable decrease in the hospital admissions albeit with a slightly favourable outcome (not statistically significant though) attributable to the first generation LAIs. There was a high incidence of unemployment and drug abuse in our cohort of patients, thus targeted interventions can be established in rehabilitation of such individuals.

The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Tournier ◽  
A. Cougnard ◽  
B. Bégaud ◽  
A. Thiébaut ◽  
H. Verdoux
Keyword(s):  
Bipolar Disorder ◽  
First Generation ◽  
Second Generation ◽  
Mood Stabilizer ◽  
Care Program ◽  
Mood Stabilizers ◽  
Lipid Lowering ◽  
Study Population ◽  
Second Generation Antipsychotic ◽  
Lowering Drug

Objective:To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.Methods:A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.Results:196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.Conclusion:Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.

Differential Impairments in Incentive Learning Caused by First‐ and Second‐ Generation Antipsychotic Drugs

2016 ◽  
Author(s):  
Matthew Florczynski
Keyword(s):  
Neural Control ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Operant Chamber ◽  
Incentive Learning ◽  
Dopamine Receptor Antagonists ◽  
Natural Response ◽  
Second Generation Antipsychotic ◽  
First And Second Generation

Schizophrenia is a neuropsychiatric disorder characterized by increased function of dopamine in the brain.  Dopamine release is a natural response to reward.  It promotes incentive learning (IL), a process by which neutral stimuli acquire the ability to elicit approach and other responses.  A recent model characterizes dopamine‐mediated IL as a progressive process with early and late stages accompanied by a shift in neural control from the nucleus accumbens (NAc) to the dorsolateral striatum (DLS).  A parallel can be drawn to differences in regionally specific neural responses generated by first‐ and second‐generation antipsychotic drugs (APDs) used to treat schizophrenia.  APDs are dopamine receptor antagonists, but first‐generation APDs affect the NAc and DLS while second‐generation APDs affect primarily the NAc.  We compared the effects of APDs on IL. Rats (N = 48) were trained to press a lever forfood pellets in an operant chamber.  Intraperitoneal injections (1 hr before testing) of the first‐generation APD haloperidol (0,0.05,0.10,0.20 mg/kg) or of the second‐generation APD risperidone (0,0.20,0.40,0.80 mg/kg) induced dose‐dependent suppression of lever pressing on days 1‐4, with the highest dose groups failing to demonstrate any evidence of previous learning on day 5 when tested drug‐free.  On days 16‐20 haloperidol induced a day‐to‐day suppression not seen with risperidone.  The results suggest that the effects of first‐ and second‐generation APDs on learning processes putatively mediated by the NAc and DLS can be differentiated experimentally.  The findings imply that APDs may differentially affect IL inpatients with schizophrenia.  

4.  Differential Impairments in Incentive Learning Caused by First‐ and Second‐ Generation Antipsychotic Drugs

2016 ◽  
Author(s):  
Matthew Florczynski
Keyword(s):  
Neural Control ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Operant Chamber ◽  
Incentive Learning ◽  
Dopamine Receptor Antagonists ◽  
Natural Response ◽  
Second Generation Antipsychotic ◽  
First And Second Generation

Schizophrenia is a neuropsychiatric disorder characterized by increased function of dopamine in the brain.  Dopamine release is a natural response to reward.  It promotes incentive learning (IL), a process by which neutral stimuli acquire the ability to elicit approach and other responses.  A recent model characterizes dopamine‐mediated IL as a progressive process with early and late stages accompanied by a shift in neural control from the nucleus accumbens (NAc) to the dorsolateral striatum (DLS).  A parallel can be drawn to differences in regionally specific neural responses generated by first‐ and second‐generation antipsychotic drugs (APDs) used to treat schizophrenia.  APDs are dopamine receptor antagonists, but first‐generation APDs affect the NAc and DLS while second‐generation APDs affect primarily the NAc.  We compared the effects of APDs on IL. Rats (N = 48) were trained to press a lever for food pellets in an operant chamber.  Intraperitoneal injections (1 hr before testing) of the first‐generation APD haloperidol (0,0.05,0.10,0.20 mg/kg) or of the second‐generation APD risperidone (0,0.20,0.40,0.80 mg/kg) induced dose‐dependent suppression of lever pressing on days 1‐4, with the highest dose groups failing to demonstrate any evidence of previous learning on day 5 when tested drug‐free.  On days 16‐20, haloperidol induced a day‐to‐day suppression not seen with risperidone.  The results suggest that the effects of first‐ and second‐generation APDs on learning processes putatively mediated by the NAc and DLS can be differentiated experimentally.  The findings imply that APDs may differentially affect IL inpatients with schizophrenia.

Sign in / Sign up

Export Citation Format

Share Document