Why are long-acting injectable antipsychotics still underused?

Bosanac, Peter; Castle, David

doi:10.1192/apt.bp.114.013565

Cited by 21 publications

(20 citation statements)

References 52 publications

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“…In practice, LAIs are typically used in patients that require chronic treatment, who have a history of poor treatment adherence, frequent relapses or hospital admissions. Until relatively recently, the use of LAIs was in decline, but the advent of second-generation LAIs, which may have fewer adverse effects, has led to calls for their more widespread use (Barnes, 2005 ; Brissos et al 2014 ; Bosanac & Castle, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

et al. 2017

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BackgroundPaliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics.MethodsEHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.ResultsPatients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) −57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82).ConclusionPaliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.

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Section: Introductionmentioning

confidence: 99%

Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

et al. 2017

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“…on a mobile phone) can be useful. Long-acting injectable (also known as depot) antipsychotic agents can be helpful if adherence is poor or uncertain (Bosanac and Castle, 2015); sometimes there is an impression of good adherence when in fact little medication is being taken. Depot medications bypass hepatic first-pass metabolism.…”

Section: Antipsychotic Medicationmentioning

confidence: 99%

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders

Galletly

Castle

Dark

et al. 2016

Aust N Z J Psychiatry

665

672

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Objectives: This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. Methods:The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RANZCP GuidelinesGalletly et al. 411 Australian & New Zealand Journal of Psychiatry, 50(5)Results: The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. Conclusions:This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.

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“…Talking with patients about the benefits and risks of treatment options J Bras Psiquiatr. 2021;70(1):68-77 such as LAIs can facilitate therapeutic engagement and care within a recovery framework 34 . Patients who perceive a positive therapeutic alliance with their psychiatrist and other staff have improved medication adherence 35 .…”

Section: Discussionmentioning

confidence: 99%

Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies

Fiore

Bertani

Marchi

et al. 2021

J. bras. psiquiatr.

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Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication.

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Why are long-acting injectable antipsychotics still underused?

Cited by 21 publications

References 52 publications

Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders

Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies

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