A two-year mirror-image study of the effect of treatment with paliperidone and aripiprazole long-acting injections on need for inpatient care and home treatment intervention

AimsTo evaluate the effect of the use of aripiprazole and paliperidone long acting injections on healthcare resource useBackgroundLong acting injections of second-generation antipsychotics such as paliperidone and aripiprazole have become more commonly prescribed over the past decade. They have much higher acquisition costs when compared to first generation depot antipsychotics. It is therefore essential to demonstrate their tolerability and cost-effectiveness.MethodWe undertook an observational, retrospective two-year mirror study for all patients who started treatment with paliperidone long acting injection between January and June 2016 (n = 47) or aripiprazole long acting injection between April 2014 and July 2017 (n = 93). Clinical notes were examined to determine the number of admissions, inpatient days, home treatment episodes and number of home treatment days, in the 12 months preceding and following the commencement of the long acting injection.Result70% remained on paliperidone and 62% remained on aripiprazole at the end of the one-year period.There was a significant reduction in occupied bed days in those treated with paliperidone from 78.2 days in the year before this treatment was started to 25.4 days in the year after (p = 0.002). There was a significant reduction in occupied bed days in those treated with aripiprazole from 66.51 days to 32.7 days (p = 0.0006).There was no significant reduction in days spent under the care of home treatment teams for individuals treated with either of these medicines.ConclusionTreatment with either paliperidone or aripiprazole long-acting injection was associated with a reduction in admissions and occupied bed days of a magnitude that delivered an overall cost-saving despite the high drug acquisition costs. It remains to be determined how these reductions compare with other second-generation long-acting injections and first-generation depot antipsychotics.

A Cohort Study of Oral and Depot Antipsychotics after First Hospitalization for Schizophrenia

This chapter provides a summary of a landmark study on schizophrenia. In patients hospitalized for the first time with a diagnosis of schizophrenia, what is the risk of rehospitalization, drug discontinuation, and total mortality? Also, which antipsychotics and routes of administration are most effective for maintenance after the first hospitalization for schizophrenia? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy

Background:This study investigates the antipsychotic use patterns of patients with schizophrenia and its correlations in their daily drug use patterns.Methods:Patients with schizophrenia who have regular records at two different community counselling centres (CCS) were included in the study. Information about their medications and sociodemographic data was recorded through face-to-face interviews and supporting information about their drug use patterns was obtained from their relatives/caregivers/nurse. The Clinical Global Impression Scale (severity of illness) and the General Assessment of Functionality scales were also administered.Results:Patients with schizophrenia used 2.0 ± 0.81 antipsychotics daily and 3.52 ± 2.55 pills (1–18). Seventy-one percent of the patients used two or more kinds of psychotropic drugs. The most frequently used antipsychotics were quetiapine, a second generation antipsychotic, and haloperidol, a typical antipsychotic. Clinical severity, regular visits to a CCS and use of depot antipsychotics were independent predictors for polypharmacy.Conclusion:The rate of polypharmacy use is high in Turkey. There are multiple risk factors related with polipharmacy. New studies should focus risk factors for preventing polypharmacy.

When it's the Time to Switch the Therapeutic Approach on Electroconvulsive Therapy for Residual Positive Symptoms in Schizophrenia?

IntroductionSchizophrenia is clearly one of the most debilitating diseases. Luckily, in the past 20 years, there has been a wide and good change in symptomatology due to the new atypical antipsychotics. Still, there are patients who are treatment resistant after different adjustments like switching or adding antipsychotics. Most of the clinicians consider Clozapine the “last resort”. But what if it doesn’t work so well on some patients?ObjectiveTo determine the point when it's time to try electroconvulsive therapy in schizophrenia treatment-resistant patients or remain on conventional approach.AimsThe aim of this work is to determine whether it's better for those patients who have residual positive symptoms to use oral/depot antipsychotics or to switch on electroconvulsive therapy.MethodsThis work presents the case of the patient C.D., 35 years, diagnosed with paranoid schizophrenia since 2008. Risperidone, Olanzapine, Aripiprazole were introduced during time, with some improvement on the positive symptomatology, but the patient developed several side-effects. At his last admission in our hospital, he came after a suicidal attempt caused by high anxiety and depression due to his false beliefs. Clozapine was introduced, but after one month of treatment, the patient still had the belief that his neighbours want to harm him somehow.ResultsThe patient and his mother definitively refused electroconvulsive therapy because of their personal beliefs. He affirmed that he can live with this “low-dose” of suspiciousness which, unfortunately, had a negative impact on his social life.ConclusionsWe still recommend electroconvulsive therapy in these situations, even though, there are many misconceptions regarding this approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antipsychotic prescribing of consultant forensic psychiatrists working in different levels of secure care with patients with schizophrenia

Aims and methodTo detect any differences in the antipsychotic prescribing practices of consultant forensic psychiatrists working in different levels of secure care with patients diagnosed with schizophrenia, and to identify potential reasons for any differences. Prescribing data were collected from four secure hospitals within one National Health Service trust. A questionnaire was sent to consultant forensic psychiatrists working at those hospitals as well as those working in the trust's community forensic services.ResultsConsultants working in high security prescribed more oral antipsychotics than consultants working in medium and low security, who prescribed more depot antipsychotics, as established via the prescribing data. The questionnaire provided insight regarding the reasons for these preferences.Clinical implicationsThere were differences in the antipsychotic prescribing practices of consultant forensic psychiatrists working in different levels of secure care, and, overall, the rate of depot antipsychotic prescribing was lower than might be expected. Although it was positive that the rate of polypharmacy was low when compared with earlier studies, the lower-than-expected rate of depot antipsychotic prescribing has clinical implications.

Comparison of hospitalization rates in schizophrenic patients on first generation versus second generation antipsychotic depots

IntroductionThere is limited data on the efficacy rates between first and second generation antipsychotic depots. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics significantly reduce hospitalizations rates as compared to conventional depots.ObjectivesComparison of hospitalization rates for patients with schizophrenia on first and second generation antipsychotic depots.MethodsA retrospective observational study was done by reviewing the records of an antipsychotic depot clinic in Essex, United Kingdom. A list of 47 patients enrolled and receiving depot antipsychotics was obtained. Their records were studied and hospital admission rates calculated.ResultsOf the 47 patients 11 were excluded as they were on depot antipsychotics for non-schizophrenic diagnoses.Of the 36 patients with schizophrenia, 12 were on second generation and 24 were on first generation depots.Amongst the 24 patients on first generation depots, 19 were male, 5 female and mean age was 52 years.Of the 12 patients on second generation depots, 10 were male and 2 female and mean age was 46 years.When comparing hospital admission rates between the 2 groups, the following data was noted (Table 1).ConclusionsThere is no difference in hospitalization rates between patients on first generation antipsychotic depots as compared to second generation antipsychotic depots.Disclosure of interestThe authors have not supplied their declaration of competing interest.