Acceptance of the Deltoid Muscle Injection of Aripiprazole Long-acting Injectable in the Patients with Schizophrenia

Abstract

Objective: To improve poor medication adherence in schizophrenic patients, long-acting injectable (LAI) antipsychotics are used. However, it has not yet become common in Japan. Recently, aripiprazole LAI was approved for alternative injection into the deltoid muscle in addition to the gluteal muscle. The acceptance for the proposal to switch from gluteal to deltoid injections of aripiprazole LAI was investigated. Methods: The subjects were 32 outpatients with schizophrenia who had continuously received aripiprazole LAI administration into the gluteal muscle for ≥ 6 months. In the patients who had continued deltoid injection for 3 months after switching, the changes in the pain and shame in comparison with gluteal injections were evaluated. Results: Switching to the deltoid injection was chosen by 17 out of 32 patients. Three months later, 9 patients were still receiving deltoid injections with highly rated satisfaction. The main reasons for switching to deltoid injections included the pain and shame associated with gluteal injections. The main reason for returning to the gluteal injection was the pain experienced from the injection in the deltoid. Conclusion: The option to select the injected area was based on the amount of pain in the deltoid and gluteal sites, leading to the widespread use of aripiprazole LAI.

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

“… 1 , 2 , 3 , 4 , 5 Antipsychotic monotherapy (APM) has been the gold standard for schizophrenia treatment, 2 , 6 , 7 , 8 , 9 however, empirically 10 to 60% of schizophrenia patients respond poorly or only partially to APM in real practice. 10 , 11 , 12 , 13 , 14 Based on recent individual patient data from randomized controlled trials (RCTs), 15 approximately 2 out of 10 patients (19.8%) starting APM failed to show any symptom improvement after acute phase treatment for more than 4 weeks, however, it increased up to 4–7 out of 10 patients (43–67%) when applying different criteria for response to AP therapy (25/50% more reduction in Positive And Negative Syndrome Scale, PANSS).…”

Antipsychotic-Related Stigma and the Impact on Treatment Choices: A Systematic Review and Framework Synthesis

“…Two studies presented evidence that patients preferred deltoid injections over gluteal injections, perceiving the deltoid site to be less embarrassing. 47 , 70 However, another study found no statistically significant difference in perceived level of shame between a group that switched from gluteal to deltoid administration and a group that did not (p=0.436). 46 Two studies found that health professionals believe deltoid injections are less stigmatising than gluteal injections.…”

“… 46 , 47 , 70 Among these, two studies reported that embarrassment was the reason for a moderate proportion of patients (~40% in both studies), 47 , 70 while the third reported only a small proportion of patients with a “meaningful level of shame”. 46 Another study noted that the patients who reported less shame with deltoid injections were all women; 47 it may therefore be relevant for future studies to investigate gender-based differences in antipsychotic-related stigma. Two international surveys of nurses reported that the majority of nurses agreed with statements indicating that deltoid injections reduce stigma.…”

“…Where reported, most recruited patients had been diagnosed with their condition or had received mental health care for several years, ranging from a mean of 5.4 to 21.2 years. The patient sample primarily comprised (>60%) females in six studies, [46][47][48][49][50][51] and males in three studies. [52][53][54] In the remaining studies, the gender distribution was relatively equal.…”

“…74,75 When deciding between deltoid and gluteal injections, three studies found that just over half of patients would prefer deltoid injections to gluteal injections. 46,47,70 Among these, two studies reported that embarrassment was the reason for a moderate proportion of patients (~40% in both studies), 47,70 while the third reported only a small proportion of patients with a "meaningful level of shame". 46 Another study noted that the patients who reported less shame with deltoid injections were all women; 47 it may therefore be relevant for future studies to investigate gender-based differences in antipsychotic-related stigma.…”