Abstract
BackgroundLong acting injections (LAI) have been associated with perceptions of coercion in cross sectional studies but there have been no longitudinal studies of the effects on clinical relationships with newer depot medications.MethodRandomized controlled trial with (50) participants with a diagnosis of schizophrenia randomized to risperidone LAI or oral atypical antipsychotic medication. The main outcome was the Working Alliance Inventory (WAI) with background variables (symptoms, side effect, social functioning, quality of life) measured before randomization and at two years.ResultsAt follow-up (14 risperidone LAI and 16 oral medication) analyses including predictors of missing data and baseline score showed a trend for those on risperidone LAI to reduce WAI score and those on oral medication showing no change. Sensitivity analyses showed (i) a significant detrimental effect of LAI on WAI and (ii) the pattern of results was not affected by change in symptoms over the study.ConclusionThis is the first study to show that the prescription of depot atypical depot medication is associated with detrimental effects on clinical relationships after 2 years of continual treatment.
Highlights
Long acting injections (LAI) have been associated with perceptions of coercion in cross sectional studies but there have been no longitudinal studies of the effects on clinical relationships with newer depot medications
At follow-up 30 people completed enough of the Working Alliance Inventory (WAI) items to achieve a WAI score (14 risperidone LAI and 16 oral medication group)
The study reports that there is a reduction in working alliance following the introduction of an LAI compared to continuing on oral medication
Summary
Long acting injections (LAI) have been associated with perceptions of coercion in cross sectional studies but there have been no longitudinal studies of the effects on clinical relationships with newer depot medications. Working alliance is the name given to the therapeutic relationship between a clinician and a patient. Evidence for long acting injectable (LAI) or depot medication affecting the therapeutic relationships is mixed. Some patients perceive long-acting depot antipsychotics to be coercive [10,11] while many clinicians maintain that depots are underutilized as they offer advantages in terms of convenience, enhanced relapse prevention with reduced rehospitalization rates [12,13,14,15]. It may be that clinicians are over-estimating adherence in those on oral medication compared to depot where compliance is monitored
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