A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections

Abstract

Objectives: The objective of this study was to investigate attitudinal themes to antipsychotic long-acting injections (LAIs) in patients in an early intervention team (EIT). Methods: Interviews were carried out with outpatients purposively sampled from an EIT to represent patients currently prescribed antipsychotic LAIs, oral antipsychotics and those not prescribed antipsychotic medication. Interviews were conducted and analysed according to grounded theory. Recruitment stopped when saturation of themes was reached. Results: Interviews from 11 patients were analysed (median age 24 years). Attitudes to LAIs were condensed into three key categories: therapeutic alliance and the psychiatrists' recommendation of antipsychotic medication; patients' knowledge and beliefs about LAIs; and patients' views regarding the appropriateness of LAIs. Participants valued their psychiatrist's recommendation as to the most appropriate antipsychotic. Attitudes to LAIs varied but were most positive among those currently receiving a LAI. Among those not prescribed LAIs, some were open to considering a LAI if their clinician recommended it but others were opposed to such treatment and preferred tables. There was a lack of awareness of LAIs as a treatment option among those not prescribed a LAI. Delay in being offered a LAI was reported in the group currently prescribed a LAI. Several participants associated oral antipsychotics, LAIs and mental illness with stigma. Some not prescribed a LAI had misperceptions about the nature of this treatment. Participants regarded the advantages of LAIs as convenience and avoiding forgetting to take tablets, while disadvantages included injection pain, fear of needles and coercion. Conclusion: Lack of knowledge, misperceptions and stigma related to LAIs and other treatment options should be addressed by providing patients with accurate information. This will facilitate patients being involved in choices about treatment, and should they decide to accept medication, which drug and formulation is most appropriate for their needs. Clinicians should avoid making assumptions about patients' attitudes to LAIs; attitudes vary but some early intervention patients not prescribed LAIs are open to considering this treatment. Antipsychotic prescribing should result from a shared decision-making process in which clinicians and patients openly discuss the pros and cons of different formulations and drugs. The themes identified in this qualitative study require further exploration using quantitative methodology.

The use of long-acting injectable antipsychotic medication

“…In cases where LAIs are offered, patient tend to show a more favourable attitude of LAIs which correlate with their knowledge of these formulations (Potkin et al 2013). This is supported by systematic review of 12 studies by Waddell and Taylor (2009) and several other studies (Heres et al 2007, Patel et al 2009, Waddell and Taylor 2009, Caroli et al 2011, Das et al 2014). …”

“…Several studies have demonstrated that LAIs are welcomed by patients or even preferred (Walburn et al 2001, Phillips and McCann 2007, Iyer et al 2013, Das et al 2014) with at least one study suggesting an unfavourable view (Patel et al 2010). In situations where patients express an unfavourable view of LAIs, this may be because they have not been fully informed of LAIs as a treatment option.…”

The Use of Long-Acting Injectable Antipsychotics in Schizophrenia

“…128,129 In many cases, physician beliefs and perceptions about LAIs may prevent patients from learning that LAIs are a potential option. 130,131 For example, in a study of communication patterns in the offer of LAIs made by psychiatrists to patients with schizophrenia at 10 health clinics, psychiatrists generally presented LAIs in a negative light, resulting in only 11 of 33 LAI recommendations (33%) being accepted by patients. 132 However, during a postvisit interview, during which LAIs were presented in a more positive light and with more information, 27 of the 28 patients (96%) who declined the initial recommendation changed their mind, stating that they actually would be willing to try LAI treatment.…”

Reducing the stigma of long acting injectable antipsychotics – current concepts and future developments

“…In a survey of 317 psychiatrists, 69% regarded LAI-APs less acceptable to the patients, 48% as stigmatising, 40% as old fashioned and 38% more prone to adverse effects [17]. Patients may indeed associate LAIs with stigma and coercion [18]. Fear of needles and injection pain may also shape negative attitudes towards LAI-APs [19].…”