Reducing long acting antipsychotic injection dosage frequency: A pilot study in a community mental health team

Fleming, Darcy; Raynsford, Justine; Hosalli, Prakash

doi:10.1080/09638237.2020.1714003

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…Despite many professionals' commitment to the importance of medication in maintaining mental wellbeing (Fleming et al, 2021), increasingly, methods of shared decisionmaking (SDM) in medication management (Fox, 2021a;Ramon et al, 2021) have been advocated to respect service users as experts in their own care. This is a process which breaks down the medical model of care, that views the professional as the expert, and reinforces the importance of coproduction in mental health services (DH, 2019/2020).…”

Section: Discussionmentioning

confidence: 99%

Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health

Fox

2024

Community Ment Health J

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This article uses autoethnography to explore the author’s lived experiences of mental distress and how she has conceptualised and explained these symptoms to herself using both the biomedical and recovery models of care. Autoethnography is a process of personal reflection that enables connection between the personal and the political. Experiences of mental distress are recounted alongside the decision to reduce medication. This personal experience is then explored in the context of limited evidence base on the effectiveness of reducing medication and the situation in which prescribers often feel reluctant to recommend and support service users in these choices. Shared decision-making in medication management is introduced which is an approach which draws on the models of recovery and co-production challenging traditional biomedical approaches which locate the prescriber as expert. Moreover, the radical service user led model is highlighted, within which, the Hearing Voices Network and Open Dialogue offer alternative approaches which promote co-production and empowerment. The author connects the personal to the political and reflects on her dual identity as an expert-by-experience and social work academic. She details how she has drawn on biomedical explanations to describe her distress yet has been challenged by the recovery model throughout her journey of recovery. She concludes that her own position, in identifying herself as an academic and expert-by-experience is an important step in challenging notions of expertise and approaches to mental health care.

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Section: Discussionmentioning

confidence: 99%

Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health

Fox

2024

Community Ment Health J

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“…It may therefore be advisable to reduce antipsychotic depots more gradually than abrupt stoppage. The above regimes offer potential solutions to tailor the dosage to individual patients, which might both journals.sagepub.com/home/tpp TherapeuTic advances in psychopharmacology reduce the impact that antipsychotic medication can have on wider physical health [18][19][20][21]52 and also reduce the demands on healthcare professionals administering LAIs, 32 whilst potentially minimising the disruption caused by withdrawal effects or destabilising patients' mental states. Many studies examining the relapse prevention properties of antipsychotics have utilised abrupt stoppage of antipsychotic depots.…”

Section: Abrupt Stopping Of Depot Medicationmentioning

confidence: 99%

“… 31 One study lengthened inter-dose interval of flupentixol from 3 to 4 weeks whilst keeping a consistent dose and found no effect on relapse of psychosis symptoms. 32 Increased intervals for olanzapine and zuclopenthixol LAIs were also tolerated, although individual injection dosages were increased slightly to compensate; dosage per week was still reduced by 20%–30% once the prolonged interval was accounted for Fleming et al 32 The authors notably did not extend intervals for aripiprazole monohydrate, citing limitations in licensing arrangements. However, the manufacturers of aripiprazole monohydrate advise that whilst at steady state, dosing intervals can be as long as 6 weeks before oral re-titration is required.…”

Section: Introductionmentioning

confidence: 99%

Implementing gradual, hyperbolic tapering of long-acting injectable antipsychotics by prolonging the inter-dose interval: an in silico modelling study

O’Neill,

Taylor,

Horowitz

2023

Therapeutic Advances in Psychopharmacology

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Gradual, hyperbolic tapering has been proposed as a method to reduce the risk of withdrawal effects and potential relapse of an underlying condition by minimising disruption of existing equilibria. We applied hyperbolic tapering principles in silico to long-acting aripiprazole to generate regimens for withdrawal in clinical practice. We derived thresholds for taper rates using existing studies and consensus. Using pharmacokinetic data for aripiprazole long-acting injectable antipsychotic (ALAI), we conducted in silico modelling to examine the impact of abrupt cessation of long-acting injectable antipsychotic (LAI) medication and the effect of prolonging inter-dose interval on plasma aripiprazole levels and consequent D2 occupancy. We also modelled transitions from LAI medication to oral medication. Regimens were designed to afford a rate of reduction between 5 and 12.5 percentage points of D2 occupancy per month. Abrupt discontinuation of ALAI was shown to lead to a maximal D2 occupancy reduction of 16.8 percentage points per month; prolongation of the inter-dose interval of ALAI produced a slower reduction. Specifically, hyperbolic tapering was afforded by prolongation of a 400 mg ALAI inter-dose interval from 4 to 7 weeks, before reducing the dose to 300 mg ALAI. This could then be administered at up to 4-week (for 6% maximal D2 occupancy change), 6-week (9% change) or 7-week (11% change) intervals. Switching to oral medication – 5, 2.5 and 1.25 mg for the three regimens, respectively – is required for ALAI to complete full cessation to prevent too rapid a reduction in D2 occupancy. Oral medication should probably be maintained at a consistent dose for 3–6 months before further reductions to account for residual LAI being concurrently eliminated. Hyperbolic dose tapering is possible with ALAI through prolongation of the inter-dose interval and may reduce the risk of relapse compared to abrupt discontinuation of LAI medication.

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An electrochemical platform of tannic acid and carbon nanotubes for the sensitive determination of the antipsychotic medication clozapine in pharmaceutical and biological samples

Saylakcı

İncebay

2021

Journal of Electroanalytical Chemistry

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Reducing long acting antipsychotic injection dosage frequency: A pilot study in a community mental health team

Cited by 4 publications

References 18 publications

Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health

Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health

Implementing gradual, hyperbolic tapering of long-acting injectable antipsychotics by prolonging the inter-dose interval: an in silico modelling study

An electrochemical platform of tannic acid and carbon nanotubes for the sensitive determination of the antipsychotic medication clozapine in pharmaceutical and biological samples

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