Management of Schizophrenia with Long-Acting Injectable Antipsychotic Medications: An Assessment of the Educational Needs of Clinicians

Abstract

Purpose Schizophrenia is a chronic and serious mental disorder characterized by disturbances in thought, perception, and behavior that impair daily functioning and quality of life. Long-acting injectable (LAI) antipsychotic medications may improve long-term outcomes over oral medications; however, LAI antipsychotic medications are often only considered as a last resort late in the disease course. This study sought to assess current clinical practice patterns, clinicians’ attitudes, and barriers to the use of LAI antipsychotic medications as well as identify unmet educational needs of psychiatric clinicians in managing patients with schizophrenia. Methods A survey was distributed via email to 2330 United States-based clinicians who manage patients with schizophrenia; 379 completed the survey and were included for analysis. The survey included five patient case-based scenarios, with seven decision points. Data were analyzed with qualitative and quantitative methodologies. Results Clinicians were most confident in determining when to initiate treatment and least confident in transitioning to injectable therapy or administering injectable therapy. Clinicians cited nonadherence, and not wanting to take daily medicine or the “hassle” of frequent treatment, as key factors for which patients were most suitable for an LAI antipsychotic medication. Patient nonadherence was considered the most important barrier to optimal management of patients with schizophrenia. A clinician’s perception of relapse was a strong driver of whether or not the clinician would discuss/recommend an LAI antipsychotic medication. Conclusion This study suggests that clinicians may be reluctant to discuss or recommend switching patients to an LAI antipsychotic medication if they are perceived as doing well on current therapy. These results will inform future research and continuing education that aims to improve the confidence, knowledge, and competence of clinicians who provide care for patients with schizophrenia who may benefit from treatment with an LAI antipsychotic medication and clinicians who may be more likely to routinely offer an LAI antipsychotic medication to their patients.

Personal and Social Functioning and Health-Related Quality of Life in Patients with Schizophrenia Treated with the Long-Acting Injectable Antipsychotic Risperidone ISM

“… 52 In contrast, nonadherence has been associated with poorer functional outcomes. 53 Therefore, treatment with Risperidone ISM of patients with schizophrenia may also be an effective way to reinforce the therapeutic alliance between patient and clinician, 54 resulting in improved adherence and acceptance of a LAI formulation 55 , 56 that avoids the need of additional boosting injections or oral risperidone supplementation, thereby providing a rapid effect on positive and negative symptoms, as well as a meaningful impact on the functioning and HR-QoL outcomes.…”

Risperidone ISM as a New Option in the Clinical Management of Schizophrenia: A Narrative Review

“…Despite the benefits of LAIs, some barriers exist regarding their use. One of the major barriers to the use of LAIs reported by psychiatrists is patient aversion to needles [ 24 ]. In addition, some patients and clinicians perceive the use of LAIs as coercive and stigmatising.…”

“…In addition, some patients and clinicians perceive the use of LAIs as coercive and stigmatising. Other barriers are the need for resources for their administration, reduced flexibility of administration that slows titration [ 24 , 25 ], and the difficulty in monitoring the occurrence and management of AEs. Also, the higher cost of second-generation LAIs can be a barrier for healthcare administration and private medicine [ 6 , 24 , 26 ].…”

“…Other barriers are the need for resources for their administration, reduced flexibility of administration that slows titration [ 24 , 25 ], and the difficulty in monitoring the occurrence and management of AEs. Also, the higher cost of second-generation LAIs can be a barrier for healthcare administration and private medicine [ 6 , 24 , 26 ]. Another barrier is the under-representation of LAIs in clinical practice guidelines, despite their efficacy and safety being assessed in several controlled clinical trials with adequate designs.…”

Patient and Healthcare Professional Preferences for Characteristics of Long-Acting Injectable Antipsychotic Agents for the Treatment of Schizophrenia

“…One barrier may be the lack of confidence in and knowledge of LAI use by psychiatrists [ 21 – 23 ]. Other obstacles for patients and medical professionals to successful LAI implementation include the need for OA supplementation and/or loading doses, inflexible dosing regimens, and intramuscular (im) administration required for many LAIs [ 24 – 27 ], along with patient aversion to needles, a stigma associated with LAIs, and a general lack of understanding of their usefulness [ 22 , 28 ]. In general, patients who prefer LAIs focus on empowerment and quality-of-life-related goals [ 29 ].…”