Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies

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.

Change of volume somatotropinpma in patients received Оctreotid-depot

According to foreign data somatotropinoma volume reduction was noted more than at a half of the patients receiving somatostatin analogs within 12 months as the first line of acromegaly treatment, however there is no data about tumor-supp ressive effect of Octreotid-depot. We assessed somatotropinoma volume during Octreotid-depot treatment in patients with an active acromegaly, and also tried to indentify possible predictors of tumor volume reduction during somastatin analogs treatment. Open prospective study include 18 patients with acromegaly (16 women, 2 men, age from 22 till 76 years old); after non-radical adenomectomy (n=5) and as first line of treatment (n=13). Patients received Octreotid-depot continuously within 12 months. Brain MRI was carried out before and after 12 months of Octreotid-depot therapy. Change of tumor volume for ≥20% from initial was interpreted as "significant". The GH level ≤2,5 ng/ml and the normal IGF-1 level were noted in 7 (38,9%) patients; GH ≤;2,5 ng/ml either the normal IGF-1 level, or simultaneous decrease in the GH and IGF-1 levels more than 50% from initial - in 8 (44,4%) patients, absence of effect from treatment - in other 3 cases. Significant tumor volume reduction was found in 12 (66,7%) of 18 cases, and degree of reduction varied from 23 to 97% (median 42% [38; 74%]); stabilization of the a tumor volume - in 5 (28%) patients; insignificant change of the sizes of a tumor (-7% and +12,5%) in other 2 patients. It wasn't revealed essential correlations between degree of tumor volume reduction and the GH and IGF-1 levels before and after somatostatin analog treatment, and also initial tumor volume.

Causal ACTH-Depot Therapy during Pregnancies following Infertility Treatment

The aim of this paper was to confirm the efficacy of adrenocorticotropin depot (ACTH-depot) therapy in pregnancies with threatened miscarriage and preterm delivery through the desired stimulation of the adrenal glands controlled by the rest of organism. The activity of hypothalamic-pituitary-adrenal axis plays a key role in pregnancy. Such naturally stimulated endogenous corticosteroid hormones are free from unwanted side effects of their synthetics analogs. Low level of maternal blood ACTH and insufficient increase of induced by hypothalamic hormones oxytocinases (cystine-β-aminopeptidases) were indication to ACTH-depot therapy (0.5 mg/week) in our consecutive prospective studies. Contrary to antenatal use of synthetic corticosteroids, there are no temporal limits of this therapy, which has to be more often recommended into clinical prevention of fetal morbidity, treatment of premature delivery, and finally elimination of the newborn's mortality caused by the neuroendocrinological gestoses.

Evaluation of Inpatient Depot Antipsychotic Prescribing

OBJECTIVE: To assess the use of fluphenazine decanoate and haloperidol decanoate in an inpatient setting. DESIGN: A prospective observational study conducted over a 3-month period. SETTING: A 400-bed state psychiatric hospital. INTERVENTIONS: The psychiatric pharmacy staff evaluated the medical records and new orders of 30 consecutive patients receiving depot antipsychotic formulations using a detailed evaluation form and the hospital pharmacy computer database. Criteria for evaluation were derived from the medical literature and product information, and included the following areas: diagnosis, stabilization on a short-acting form of the antipsychotic, appropriateness of dosage conversion to depot therapy, concomitant administration of short-acting antipsychotics (and duration of concomitant medications), and plasma concentration monitoring. RESULTS: Only 7 patients (23%) received what would be considered optimal depot antipsychotic therapy. These patients were receiving a stable dosage of a short-acting antipsychotic prior to conversion to depot therapy (i.e., ≥7 d), received optimal dose conversion to a depot form, and received optimum overlap with a short-acting preparation (i.e., overlap ≤7 d with fluphenazine HCl and 7–30 d with haloperidol HCl). When length of stay data were evaluated, no significant differences were observed in patients who received optimal therapy versus those who did not. There was also no difference in length of stay when the study group was compared with an age-, sex-, and diagnosis-matched cohort group. However, quantitatively fewer adverse effects were reported for patients whose treatment was considered optimal on the basis of the evaluation criteria. CONCLUSIONS: Depot antipsychotic therapy frequently did not meet the criteria for optimal use. This did not affect length of hospital stay in these individuals. However, individuals who met the criteria experienced quantitatively fewer adverse events.

Sex Hormones Regulate ABR Latency

In an effort to characterize more completely the influence of sex hormones on auditory brainstem response (ABR) latency, we evaluated the ABRs of normal male and female subjects and women with previously diagnosed endocrinologic syndromes. We describe ABR latency results from the following subjects: five normal males, nine normally cycling females on no hormonal therapy, nine females using oral contraceptive pills, five females with premature ovarian failure (POF) undergoing cyclic estrogen-progesterone replacement therapy, and five hyperandrogenized females with polycystic ovarian disease (PCOD) treated with the gonadotropin-releasing hormone agonist, Lupron depot, to suppress ovarian steroid production. All subjects were between 23 and 40 years of age. Serum levels of estradiol, progesterone, testosterone, prolactic, and gonadotropins (lutienizing hormone and follicle stimulating hormone) were measured to document the hormonal status of each of the subjects at the time of the ABR evaluation. Normal cycling females and females with POF underwent ABR testing during different phases of the same cycle. Male subjects and females using birth control pills were studied four times in the same month at 1-week intervals. Females with PCOD were also studied four times; baseline and then at 2-week intervals after the initiation of Lupron depot therapy. Increased ABR wave V peak latencies were found to be associated with elevated levels of estrogen or testosterone. We have previously reported a lengthening of ABR wave V peak latencies coincident with peak estrogen levels during the female cycle. Because testosterone is converted to estrogen by central neuroendocrine tissue to exert its effect on brain function, we postulated that increased latency in males is a result of the effect of aromatization of testosterone to estrogen in the central auditory pathway. This hypothesis would account for the slightly increased wave V peak latencies found in the PCOD females with elevated testosterone before treatment with Lupron to suppress ovarian androgen secretion. These findings suggest that neural conduction time is modified by changes in estrogen concentrations in the brainstem auditory pathway of both sexes.