scholarly journals Antipsychotic long-acting injections: Mind the gap

2009 ◽  
Vol 195 (S52) ◽  
pp. s1-s4 ◽  
Author(s):  
Maxine X. Patel ◽  
Mark Taylor ◽  
Anthony S. David
Keyword(s):  
Treatment Adherence ◽  
Patient Group ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Maintenance Medication ◽  
Oral Antipsychotic ◽  
Long Acting

SummaryLong-acting injections of antipsychotic medication (or depots) were developed specifically to promote treatment adherence and are a valuable option for maintenance medication in psychotic illnesses. Approximately 40–60% of patients with schizophrenia are partially or totally non-adherent to their antipsychotic regimen, but only 30% or less are prescribed a long-acting injection. The use of such injections has declined in recent years after the introduction of second-generation (atypical) oral antipsychotic drugs. Research shows that possible reasons for this decline include concerns that may be based on suboptimal knowledge, as well as an erroneous assumption that one's own patient group is more adherent than those of one's colleagues. Research on attitudes has also revealed that psychiatrists feel that long-acting injections have an ‘image’ problem. This editorial addresses the gaps in knowledge and behaviour associated with possible underutilisation of these formulations, highlighting the role of stigma and the need for more research.

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.

scholarly journals T236. A PROGRAM TO INCREASE THE APPROPRIATE USE OF LONG-ACTING ANTIPSYCHOTIC MEDICATIONS IN COMMUNITY SETTINGS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S322-S323
Author(s):  
Dawn Velligan ◽  
Martha Sajatovic
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Antipsychotic Medication ◽  
Poor Adherence ◽  
Shared Decision ◽  
Appropriate Use ◽  
Antipsychotic Medications ◽  
Oral Antipsychotic ◽  
Long Acting ◽  
Over Time

Abstract Background Antipsychotic medications are evidence-based treatments for schizophrenia that improve health outcomes and reduce costs. However, rates of non-adherence to oral antipsychotic medications can exceed 60%. We examined whether a simple checklist to identify individuals not receiving optimum benefit from current oral antipsychotic treatment (NOB Checklist) and The Multi-level Facilitation of Long-acting Antipsychotic Medication Program (MAP) could increase the appropriate use of long-acting injectable antipsychotic medication (LAI) in community clinics. Methods Two clinics in Texas and two in Ohio changed clinical procedures in one of two ways 1) NOB only clinics--providers used a five-item checklist to identify individuals with schizophrenia on oral antipsychotics who were Not receiving Optimum Benefit from current treatment and may therefore benefit from a switch to LAI. 2) MAP- providers used the NOB checklist AND received MAP; MAP is a novel behavior change intervention designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer for whom peer specialists showed a video describing shared decision making and how to make a choice between tablets and injections, and provided a balanced shared-decision making tool to assist them in choosing medication route,2) the provider who received academic detailing describing various LAI options, how to make good offers as part of a shared decision making dialogue, and important benefits of LAI including the ability to disentangle efficacy versus poor adherence and to help individuals with cognitive and practical problems that lead to poor adherence, and 3) the administrators who received information on how LAI could improve outcomes for individuals and clinic processes, how to encourage the use of LAI among providers and how to provide regular feedback to providers about prescribing practices. The primary outcome was the percentage of LAI versus oral antipsychotic medication prescribed to individuals with schizophrenia. Results Higher NOB checklist scores were associated with an increased provider likelihood of LAI offers and increased consumer acceptance of LAI. All clinics increased use of LAI over time. In Texas, where MAP was fully implemented, the MAP clinic had greater use of LAI over time (eventually reaching about 50% of all antipsychotic use) vs. the NOB only clinic. In Cleveland, the patient stakeholder curriculum was not delivered and there was no significant difference in LAI use between MAP and NOB clinics. Discussion The NOB checklist appears to be a useful tool to help identify patients who might be appropriate candidates for LAI and the full MAP program may help clinicians and consumers to work together to optimize the appropriate use of LAI in outpatient settings. Implementation must be customized for clinics and workflows to determine which parts of the MAP program are practical and appropriate. Participation of consumer stakeholders may be essential to delivery of the MAP Program.

scholarly journals Treatment patterns in Medicaid patients with schizophrenia initiated on a first- or second-generation long-acting injectable versus oral antipsychotic

2017 ◽  
Vol Volume 11 ◽  
pp. 619-629 ◽  
Author(s):  
Dominic Pilon ◽  
Kruti Joshi ◽  
Neeta Tandon ◽  
Marie-Hélène Lafeuille ◽  
Rhiannon Kamstra ◽  
...  
Keyword(s):  
Second Generation ◽  
Treatment Patterns ◽  
Oral Antipsychotic ◽  
Long Acting

Psychosis breakthrough on antipsychotic maintenance: results from a nationwide study

2019 ◽  
Vol 50 (8) ◽  
pp. 1356-1367 ◽  
Author(s):  
Jose M. Rubio ◽  
Heidi Taipale ◽  
Christoph U. Correll ◽  
Antti Tanskanen ◽  
John M. Kane ◽  
...  
Keyword(s):  
Median Duration ◽  
Incidence Rates ◽  
Continuous Treatment ◽  
Future Research ◽  
Schizophrenia Spectrum Disorders ◽  
Maintenance Medication ◽  
Schizophrenia Spectrum ◽  
Treatment Onset ◽  
Long Acting

AbstractBackgroundThere is uncertainty about the incidence of breakthrough psychosis in treatment adherent patients, and the role that factors, such as cumulative antipsychotic exposure, play in this phenomenon.MethodsIn a nationwide cohort of individuals treated for schizophrenia-spectrum disorders in Finland between 1 January 1996 and 31 December 2015, ‘Breakthrough Psychosis on Antipsychotic Maintenance Medication’ (BAMM) was defined as hospitalization for psychosis despite ongoing continuous treatment with long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs) for ⩾8 weeks. Incidence rates, survival curves, and risk factors were presented.ResultsIn a cohort of 16 031 continuous LAI treatment episodes with virtually assured adherence [median duration = 441 days, interquartile range (IQR) = 155–1277], BAMM incidence was 31.5%. For 42 867 OAPs treatment episodes (median duration = 483 days, IQR = 167–1491), for whom adherence was modeled by the PRE2DUP method, BAMM incidence was 31.1%. Factors related to illness instability at treatment onset were associated with BAMM, although median time to BAMM was 291 days (IQR = 121–876) for LAIs and 344 days (IQR = 142–989) for OAPs, and 27.4% (N= 1386) of the BAMM events in the LAI, and 32.9% (N= 4378) in the OAP group occurred despite >1 year since last hospitalization at treatment onset. Cumulative antipsychotic exposure was not a consistent risk factor.ConclusionBAMM was relatively common even when adherence was confirmed with LAIs. Illness instability at treatment onset accounted for most cases, but relapse after years of continuous treatment was still prevalent. There was insufficient evidence to support causality between cumulative antipsychotic exposure and BAMM. Future research needs to address the role of symptom severity and neurobiology in BAMM.

scholarly journals Choking deaths: the role of antipsychotic medication

2003 ◽  
Vol 183 (5) ◽  
pp. 446-450 ◽  
Author(s):  
David Ruschena ◽  
Paul E. Mullen ◽  
Simon Palmer ◽  
Philip Burgess ◽  
Stephen M. Cordner ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Public Mental Health ◽  
Case Register ◽  
Blood Samples ◽  
Risk Of Death ◽  
Increased Risk ◽  
Psychiatric Syndrome ◽  
Public Mental Health Services

BackgroundAn increased risk of choking associated with antipsychotic medication has been repeatedly postulated.AimsTo examine this association in a large number of cases of choking deaths.MethodCases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared.ResultsThe 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was, respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented.ConclusionsThe increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromes is consistent with the consequences of compromised neurological competence.

scholarly journals Prolactin levels in antipsychotic treatment of patients with schizophrenia carrying the DRD2*A1 allele

2004 ◽  
Vol 185 (2) ◽  
pp. 147-151 ◽  
Author(s):  
Ross Mcd. Young ◽  
Bruce R. Lawford ◽  
Mark Barnes ◽  
Simon C. Burton ◽  
Terry Ritchie ◽  
...  
Keyword(s):  
Receptor Binding ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Serum Prolactin ◽  
Antipsychotic Treatment ◽  
Binding Agent ◽  
Dopamine Receptor Antagonist ◽  
Combined Medication ◽  
Significant Health

BackgroundHyperprolactinaemia induced by D2 dopamine receptor antagonist antipsychotic medication can result in significant health problems.AimsTo examine the role of DRD2 polymorphism on prolactin levels in patients treated with antipsychotic medication.MethodAntipsychotic drugs with different degrees of D2 receptor binding were given to 144 patients with schizophrenia. Serum prolactin levels were obtained and Taq1A DRD2 alleles were determined.ResultsProlactin levels increased across medication groups reflecting increasingly tight D2 receptor binding (clozapine, olanzapine, typical antipsychotics and risperidone). In the combined medication group, patients with the DRD2∗A1 allele had 40% higher prolactin levels than patients without this allele. In patients treated with clozapine (the loosest D2 receptor binding agent), patients with the DRD2∗A1 allele had prolactin levels twice those of patients without this allele.ConclusionsPatients with the DRD2A1 allele receiving antipsychotic medications had higher prolactin levels and were overrepresented among those with hyperprolactinaemia, suggesting greater functional D2 receptor binding in this group.

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