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

Gianluca Fiore,Mattia Marchi,Davide Elia Bertani,Gian Maria Galeazzi,Graça Cardoso

doi:10.1590/0047-2085000000311

Abstract

ABSTRACT 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.

Highlights

Psychotic disorders are a group of severe mental disorders, characterised by the presence of various combinations of symptoms such as delusions, hallucinations, disorganised behaviours, and cognitive, affective, and expressive impairment
Being treated with long-acting injectable antipsychotic (LAI) was felt as a means to prevent relapses and hospitalisations[16,20], as well as to acquire a greater sense of control over the disorder[19]
Given the variety of populations and the consistency of results, the analysis suggests that the included studies provide a reasonably representative view of the typical experience of taking LAI antipsychotic medication emerging from qualitative research

Summary

Introduction

Psychotic disorders are a group of severe mental disorders, characterised by the presence of various combinations of symptoms such as delusions, hallucinations, disorganised behaviours, and cognitive, affective, and expressive impairment. Schizophrenia is the most known of this group of disorders, affecting up to 0.7 % of the population (20 million people worldwide according to the Global Burden of Disease 2017 study)[1]. Up to 50% of patients with schizophrenia show partial or total lack of adherence to pharmacological prescriptions[3,4,5]. The causes of this phenomenon are complex and include patients’ factors (preference, cognitive problems, personality, insight, relationship with the prescribing physician), the very characteristics of the drugs (such as side effects, treatment duration, little or no therapeutic efficacy) and stigma towards mental disorders and medications used to treat them[6,7]. Incomplete or total lack of adherence to treatment is associated with symptoms relapse, at times leading to hospital admission

Methods

Results

Discussion

Conclusion