Enhancing Outcomes: Acceptability of Medication Formulations for the Treatment of Acute Agitation in a Psychiatric Population

Abstract

BACKGROUND: There is limited research evaluating patient acceptability of medication formulations in the treatment of acute agitation. This study assessed patient acceptability of medication formulations (tablet, orally-dissolving-tablet [ODT], liquid, intramuscular injection [IM], inhaled device [INH]) for the treatment of acute agitation and examined correlating factors. METHODS: Adults with psychotic illness or bipolar disorder receiving emergency or inpatient services at an inpatient psychiatric facility in Kansas City, Missouri were included. Participants viewed a presentation on medication formulations for acute agitation and were surveyed on acceptability (measured on a five-point Likert scale). The primary outcome variable was the attitudinal measurement of acceptability of each formulation in correlation with the severity of agitation for use in themselves and other patients. RESULTS: One hundred participants completed the survey. Participants rated the following: (1) This medication formulation would be acceptable to treat mild agitation in themselves and others (oral tablet 85% and 48%; ODT 82% and 55%; liquid 74% and 51%; IM 53% and 74%; INH 78% and 72%); and (2) This medication formulation would be acceptable to treat severe agitation in themselves and others (oral tablet 75% and 52%; ODT 74% and 53%; liquid 66% and 53%; IM 61% and 67%; INH 77% and 72%). For treating mild agitation, participants preferred tablets and ODTs to the IM (p < 0.05) and the INH to liquid or IM (p < 0.05), for themselves; and oral formulations were preferred to the IM (p < 0.05) for other patients. For severe agitation in themselves and others, preference for the INH and IM versus oral formulations (p < 0.05) was significant, with no difference between the INH and IM (p > 0.05). CONCLUSIONS: The proportion of responses preferring oral formulations was higher than IM and INH. Dosage formulation acceptability differed depending on the severity of agitation and intended recipient of the medication.

Cariprazine Orodispersible Tablet: A New Formulation for Cariprazine

“…A recent study on patient’s acceptance of medication formulations for acute agitation found that there was a clear preference for oral formulations over intramuscular or inhaled formulations 15 . This finding is particularly important, as treatment guidelines now recommend that patient preferences are considered in treatment choices (shared decision-making or informed choice) 15 . A survey of hospitalized patients with schizophrenia in 2010 showed that 42% wanted to be involved in treatment decisions 15 .…”

“…This finding is particularly important, as treatment guidelines now recommend that patient preferences are considered in treatment choices (shared decision-making or informed choice) 15 . A survey of hospitalized patients with schizophrenia in 2010 showed that 42% wanted to be involved in treatment decisions 15 . Patients involved in their treatment decisions had a better therapeutic relationship, more positive attitudes towards their medication, and better insight than patients who were not involved 15 .…”

“…A survey of hospitalized patients with schizophrenia in 2010 showed that 42% wanted to be involved in treatment decisions 15 . Patients involved in their treatment decisions had a better therapeutic relationship, more positive attitudes towards their medication, and better insight than patients who were not involved 15 . So, although some doctors may prefer injectable formulations for adherence, patients still prefer oral formulations.…”

Medicine Use in Chronic Diseases

“…A significant part of medication use in individuals with chronic conditions is their engagement in their care and their ability to be a part of the treatment decision-making process. Walker et al studied the need for patient input while choosing the medication formulation for acute agitation in behavioral emergencies [ 1 ]. Understanding these preferences and prescribing accordingly is critical to improving the acceptability of the medicine, medication adherence, and therapeutic alliance.…”