The Use of Long-Acting Injectable Antipsychotics (LAI) in the Serious Mental Illness (SMI) Patients Enrolled in an Assertive Community Treatment (ACT) Program

Yee, Maria Ruiza; Espiridon, Eduardo; Oladunjoye, Adeolu O; Millsaps, Udema; Vora, Anish; Harvey, Nailah

doi:10.7759/cureus.14490

Cited by 2 publications

(13 citation statements)

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“…Serious mental illness, as defined by the National Institute of Mental Health (NIMH) is a mental, behavioral or emotional disorder resulting in serious functional impairment which substantially interferes with or limits one or more major life activities [1]. SMI is made up of a smaller group of mental health illnesses and a more severe type of mental illness [2]. NIMH reports that approximately 13.1 million or 5.2% of American adults age 18 or over, as of 2019 have SMI [1], with the highest prevalence in young adults, ages 18 to 25 [1].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with SMI experience highly intractable symptoms and great levels of dysfunction from their mental illness [2]. Patients who suffer from SMI do not respond to standard outpatient psychiatric care and will need an alternative that is effective and efficient.…”

Section: Introductionmentioning

confidence: 99%

“…Assertive Community Treatment (ACT) program is an effective [4][5][6], and cost-effective treatment [7][8][9] in this group of individuals, especially in those with extensive prior hospital utilization. ACT program not only results in a reduction of psychiatric hospitalization but also, more stable socioeconomic condition [2]. Patients with SMI involved in an ACT program are individuals who experience the most intractable symptoms and the greatest level of dysfunction from their mental illness.…”

Section: Introductionmentioning

confidence: 99%

“…A typical team membership includes 10 to 12 professionals from the different fields in mental health including fields of psychiatry, psychology, and other allied health care professionals who provided services needed by these patients [5]. Services are provided every time of the day and every day of the week [2]. Patients are taught life skills for real-life situations as well [2].…”

Section: Introductionmentioning

confidence: 99%

“…Services are provided every time of the day and every day of the week [2]. Patients are taught life skills for real-life situations as well [2].…”

Section: Introductionmentioning

confidence: 99%

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The Use of Clozapine in the Serious Mental Illness Patients Enrolled in an Assertive Community Treatment Program

Yee

Espiridon

Oladunjoye

et al. 2021

Cureus

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Introduction Health care cost is projected to reach 20% of the nation’s gross national product (GNP) by 2016. 6.2% of this is from mental health. The National Institute of Mental Health (NIMH) estimates the prevalence of serious mental illness (SMI) at 13.1 million or 5.2% of American adults age 18 or over. Hence, mental health care cost for this patient population is significant. Patients with SMI involved in an Assertive Community Treatment (ACT) program are individuals who experience the most intractable symptoms and the greatest level of dysfunction from their mental illness. These individuals typically are institutionalized in a long-term facility such as the state hospital. Clozapine has shown superior efficacy over first- and most second-generation antipsychotics in both treating treatment-resistant and non-treatment-resistant schizophrenia which has been supported by several large trials. There is also evidence of its efficacy in suicidality, aggression and substance misuse. In fact, clozapine has been approved by the FDA for use in refractory schizophrenia and suicidality in schizoaffective disorder. Due to the risk of agranulocytosis, clozapine is underutilized. The purpose of this study is to conduct a retrospective cohort study through chart review to analyze whether the addition of clozapine to ACT treatment of SMI patients in a community hospital from 2008 to 2018 led to decreased frequency of hospitalizations and increased clinical stability. Materials and methods A retrospective study using electronic medical record (EMR) of patients ages 20 and above who were enrolled in the ACT program at a community hospital from December 1, 2008 to December 31, 2018. Variables were collected from the EMR and de-identified during data collation. Analysis was performed using SPSS software package. Results A total of 179 patients enrolled in the ACT program and their data was extracted from the EMR. Twenty-five (62.5%) of these patient enrollments were on clozapine. They were made up of 53.6% male, 81.9% White/Asian, 18.1% Black; 44.1% ages between 36 to 50 years old, 30.2% were aged 18 to 35 years old, and 25.7% greater than 50 years old. There was no difference in age, sex, race, ethnicity, and insurance type in ACT program between those using clozapine and those not on clozapine. There was a higher proportion of psychiatric hospitalizations among clozapine users compared with the non-clozapine user group (62.5% vs 41.5%, p = 0.019). However, the two groups did not differ from one another in terms of psychiatric emergency visits (p = 0.128) or frequency of ACT visits (p = 0.002). Conclusion Effective treatment that will reduce hospitalizations and the burden of chronic disability in patients with SMI would greatly reduce mental health care cost. Clozapine remains the gold standard in the treatment of refractory schizophrenia. But due to the risk of agranulocytosis, clozapine is underutilized. It was hoped th...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Services are provided every time of the day and every day of the week [2]. Patients are taught life skills for real-life situations as well [2].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Use of Clozapine in the Serious Mental Illness Patients Enrolled in an Assertive Community Treatment Program

Yee

Espiridon

Oladunjoye

et al. 2021

Cureus

Self Cite

View full text Add to dashboard Cite

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Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations

et al. 2023

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Background: Long-acting injectable (LAI) antipsychotics (APs) each have an oral equivalent formulation, while aripiprazole, olanzapine, and ziprasidone each also have a short-acting injectable (SAI) equivalent formulation. Inpatient prescribing patterns of LAIs and their oral/SAI equivalents are less characterized in populations other than Medicaid, Medicare, and Veterans Affairs populations. Mapping out inpatient prescribing patterns remains an important first step to ensure appropriate use of antipsychotics during this critical juncture of patient care prior to discharge. This study determined inpatient prescribing patterns of first- (FGA) and second-generation antipsychotic (SGA) LAIs and their oral/SAI formulations.Methods: This was a large retrospective study using the Cerner Health Facts® database. Hospital admissions due to schizophrenia, schizoaffective disorder, or bipolar disorder from 2010 to 2016 were identified. AP utilization was defined as the proportion of inpatient stays during which at least 1 AP was administered to the total number of inpatient visits over the observed period. Descriptive analyses were used to determine prescribing patterns for APs. Chi-square tests were used to determine utilization differences across years.Results: 94,989 encounters were identified. Encounters during which oral/SAI of SGA LAIs were administered were most common (n = 38,621, 41%). Encounters during which FGA LAIs or SGA LAIs were administered were the least common (n = 1,047, 1.1%). Prescribing patterns differed across years (p < 0.05) within the SGA LAI subgroup analysis (N = 6,014). Paliperidone palmitate (63%, N = 3,799) and risperidone (31%, N = 1,859) were the most frequently administered. Paliperidone palmitate utilization increased from 30% to 72% (p < 0.001), while risperidone utilization decreased from 70% to 18% (p < 0.001).Conclusions: Compared with their oral or SAI formulations, LAIs were underutilized from 2010 to 2016. Among SGA LAIs, the prescribing patterns of paliperidone palmitate and risperidone changed significantly.

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The Use of Long-Acting Injectable Antipsychotics (LAI) in the Serious Mental Illness (SMI) Patients Enrolled in an Assertive Community Treatment (ACT) Program

Cited by 2 publications

References 11 publications

The Use of Clozapine in the Serious Mental Illness Patients Enrolled in an Assertive Community Treatment Program

The Use of Clozapine in the Serious Mental Illness Patients Enrolled in an Assertive Community Treatment Program

Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations

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