Clinical Decision-Making in the Treatment of Schizophrenia: Focus on Long-Acting Injectable Antipsychotics.

Ludovic Samalin,Candy Auclair,Pierre-Michel Llorca,Marion Garnier

doi:10.3390/ijms17111935

Abstract

The purpose of this study was to identify clinician characteristics associated with higher prescription rates of long-acting injectable (LAI) antipsychotics, as well as the sources that influence medical decision-making regarding the treatment of schizophrenia. We surveyed 202 psychiatrists during six regional French conferences (Bordeaux, Lyon, Marseille, Nice, Paris, and Strasbourg). Data on the characteristics of practice, prescription rates of antipsychotic, and information sources about their clinical decisions were collected. Most psychiatrists used second-generation antipsychotics (SGAs), and preferentially an oral formulation, in the treatment of schizophrenia. LAI SGAs were prescribed to 30.4% of schizophrenic patients. The duration and type of practice did not influence the class or formulation of antipsychotics used. The clinicians following the higher percentage of schizophrenic patients were associated with a higher use of LAI antipsychotics and a lower use of oral SGAs. Personal experience, government regulatory approval, and guidelines for the treatment of schizophrenia were the three main contributing factors guiding clinicians’ decision-making regarding the treatment of schizophrenia. The more clinicians follow schizophrenic patients, the more they use LAI antipsychotics. The development of specialized programs with top specialists should lead to better use of LAI antipsychotics in the treatment of schizophrenia.

Highlights

Schizophrenia is a chronic illness with a high risk of relapse that is frequently associated with treatment discontinuation
The aim of our study was to identify (i) the characteristics of practice associated with higher long-acting injectable (LAI) antipsychotic prescription rates; and (ii) the sources of information that influence medical decision-making regarding the treatment of schizophrenia
Clinicians declared that they prescribed oral second-generation antipsychotics (SGAs) to more than half of their patients and LAI SGAs to 30% of their patients

Summary

Introduction

Schizophrenia is a chronic illness with a high risk of relapse that is frequently associated with treatment discontinuation. Ensuring treatment adherence is one of the principal challenges in schizophrenia management This requires awareness of several risk factors (e.g., symptoms of the illness, stigmatization, poor therapeutic alliance, and a complex medication schedule) [1]. The development of long-acting injectable first-generation antipsychotics (LAI FGAs) in the 1960s and, more recently, of long-acting injectable second-generation antipsychotics (LAI SGAs) has been an important step in the management of schizophrenia. These formulations are considered as one of the most efficacious pharmacological interventions available to address adherence problems in patients suffering from schizophrenia [2,3]. They offer several advantages, including transparency of adherence and the possibility of early intervention of healthcare professionals if patients fail to take their medication, as well as, from a pharmacokinetic perspective, more consistent bioavailability and reduced peak-trough plasma levels [2,4]

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Conclusion