Why we should use long-acting injectable antipsychotics more frequently

Maia‐de‐Oliveira, João Paulo; Bressan, Rodrigo A.; Elkis, Hélio; Machado‐de‐Sousa, João Paulo; Hallak, Jaime Eduardo Cecílio

doi:10.1590/1516-4446-2013-3503

Cited by 8 publications

(2 citation statements)

References 7 publications

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“…First, LAI use facilitates close monitoring of adherence which is particularly important in the early phases of psychotic illness (Tiihonen et al, 2011). Second, patients may prefer the longer dosing interval, and third, single dosing prevents the risk of self-medication and harmful use that can occur with oral preparations (Maia-de-Oliveira et al, 2013; Patel and Davis, 2005). Finally, due to higher bioavailability and lower fluctuations in serum level (Ereshefsky and Mascarenas, 2003 ) , the pharmacokinetics of LAIs may promote lower effective dosing to improve tolerability.…”

Section: Introductionmentioning

confidence: 99%

Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome

Olagunju

Clark

Baune

2019

Aust N Z J Psychiatry

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Objective: Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. Methods: We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. Results: A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I 2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I 2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short-and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. Conclusion: Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.

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Section: Introductionmentioning

confidence: 99%

Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome

Olagunju

Clark

Baune

2019

Aust N Z J Psychiatry

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“…Several studies have shown that the prevention of psychotic relapse has major implications for the minimization of damage and of some disabilities that typically affect patients with schizophrenia 26,27 , and the results described here suggest that SNP may represent a new approach for the management of the disorder.…”

Section: Discussionmentioning

confidence: 58%

Effects of sodium nitroprusside in the prevention of schizophrenia-like symptoms induced by ketamine – A translational double-blind study

Rezende

Maia‐de‐Oliveira

Kandratavicius

et al. 2017

Arch. Clin. Psychiatry (São Paulo)

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Background: Recent evidence has shown improvements in schizophrenia symptoms after the infusion of sodium nitroprusside (SNP), a nitric oxide (NO) donor. In the rat model of schizophrenia using ketamine injection, pretreatment with SNP seems to prevent behavioral changes associated with positive symptoms for up to one week. Objective: We investigated whether SNP would have preventative effects on psychogenic symptoms induced by ketamine in healthy subjects. Methods: Healthy subjects (N = 38) were assigned to distinct groups that received SNP in different doses (0.15, 0.25, and 0.5 mcg/kg/min). First, participants received an infusion of SNP or placebo over 75 minutes. After 10 minutes, they were injected for 1 minute with a bolus of 0.26 mg/kg of ketamine and a maintenance dose was started 5 minutes later, with 0.25 mg/kg/h of ketamine for 50 minutes. Results: Ketamine-induced psychopathological alterations induced were reduced by SNP, as assessed with the Brief Psychological Rating Scale. Scores in the objective subscale of the Clinician-Administered Dissociative States Scale were also lower in SNP sessions compared to placebo. SNP had protective effects against deterioration in facial emotion and identity recognition tasks induced by ketamine. Discussion: Our findings support the view that SNP has preventative properties against psychotic manifestations.

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Does formulation matter? A systematic review and meta-analysis of oral versus long-acting antipsychotic studies

Ostuzzi

Bighelli

et al. 2017

Schizophrenia Research

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Why we should use long-acting injectable antipsychotics more frequently

Cited by 8 publications

References 7 publications

Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome

Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome

Effects of sodium nitroprusside in the prevention of schizophrenia-like symptoms induced by ketamine – A translational double-blind study

Does formulation matter? A systematic review and meta-analysis of oral versus long-acting antipsychotic studies

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