Long-acting Injectable Antipsychotics Research Articles

Patients on long-acting injectable antipsychotics: should we test for cytochrome P450 polymorphisms?

Patients on long-acting injectable antipsychotics: should we test for cytochrome P450 polymorphisms?

Oral versus long-acting injectable antipsychotic in first episode schizophrenia: A 12 weeks interventional study.

There is underutilization of long-acting injectable (LAI) antipsychotics for first-episode schizophrenia (FES) despite having convenient dosing and treatment retention. LAIs are predominantly used for patients with poor compliance, chronic course, and multiple relapses. Seventy-two treatment naïve patients with the first episode of Schizophrenia (DSM-5) were assessed for baseline severity of psychopathology using the positive and negative syndrome scale (PANSS) and quality of life (QOL) using the WHOQOL-BREF scale. Patients were randomized to receive either oral haloperidol or LAI haloperidol for a period of 12 weeks. Both the groups had a significant reduction in PANSS scores and improvement in QoL over 12 weeks period (P = 0.0001). The LAI group showed greater adherence and significantly better quality of life than the oral group (P = 0.023). The mean numbers of side effects were less in the LAI group at week 2 as compared to the oral group. LAI haloperidol is similar to oral haloperidol in patients with FES with respect to treatment response and offers benefits in form of a lesser number of side effects during early treatment, overall better adherence rates, and better QOL.

LONG-ACTING INJECTABLE ANTIPSYCHOTICS IN SCHIZOPHRENIA

Antipsychotics serve as the cornerstone of pharmacological treatment for schizophrenic disorders, including both the management of acute episodes and the prevention of relapse. Longacting injectable antipsychotics (LAIAs) are intended to improve treatment compliance, thereby reducing the risk of relapse and hospitalization. The marketing of LAIAs has increased over the past few years, consequently expanding the range of active substances and extending dosing intervals (bi-weekly, monthly, quarterly and semi-annually). This new situation represents a qualitative change in the available therapeutic approaches for schizophrenia, although a risk/benefit assessment is required, and the prescribing efficiency from an overall patient health perspective needs to be studied.

Možnost ovlivnění duševního zdraví u pacientů s farmakorezistentní schizofrení – augmentace klozapinu dlouhodobě působícími parenterálními antipsychotiky: série případů

Introduction: The rate of pharmacoresistance among in patients diagnosed with schizophrenia is around 30%. Clozapineis the drug of choice for these patients; however, an adequate response to treatment doesn’t always occur. One of the possible augmentation approaches, specifically for non-adherent patients, is the administration of long-acting parenteral antipsychotics. Our goal was to evaluate previous experiences of administering a combination of the atypical antipsychotic clozapine and long-acting injectable antipsychotics to pharmacoresistant patients at the Department of Psychiatry the Czech Republic and to assess the safety and effectiveness of such administration. Methods: A retrospective evaluation of patient case studies was conducted for those who were hospitalized in the Ward for the therapy of Psychotic disorders between 2016 and 2020 and had a medication history of combining clozapine and depot antipsychoticsResults: Over half of the patients had no illness relapses during the observed period. The clinical manifestation of adverse effects from combination therapy appears low in our patient sample, primarily involving mild and pharmacologically manageable side effects (tachycardia). Only one of the cases recorded neutropenia, which led to discontinuation of clozapine; the patient was maintained on long-acting injectable antipsychotics medication. Conclusion: From our findings, it can be inferred that augmenting clozapine with depot antipsychotics is a potential therapeutic intervention that pharmacoresistant patients could benefit from. However, it is essential to emphasize that this therapeutic approach should only be administered after carefully considering the patient’s existing treatment. It should be strictly individualized based on the treating physician’s or clinical pharmacist’s sufficient professional experience.

Long-acting injectable antipsychotics in dual disorders: a preliminary analysis of a pre-post intervention study

Long-acting injectable antipsychotics in dual disorders: a preliminary analysis of a pre-post intervention study

Metabolic alterations in patients treated with long-acting injectable (LAI) antipsychotics: an observational study

Metabolic alterations in patients treated with long-acting injectable (LAI) antipsychotics: an observational study

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Effectiveness of oral versus long-acting injectable second-generation antipsychotics in suicide prevention among people with severe schizophrenia

Effectiveness of oral versus long-acting injectable second-generation antipsychotics in suicide prevention among people with severe schizophrenia

Caveats of mental healthcare act-2017: Recommendation for amendments.

Dear Sir, The rights-based framework in the current Mental Healthcare Act 2017 (MHA-2017) has received a wider acceptance in the minds of policymakers, patients, caregivers, judicial officers, and mental health professionals.[1,2] However, there appears to be a huge gap between acceptance in our minds and implementation at the ground level. Theoretical knowledge of MHA-2017 and the inability to translate it into practice in most of the general hospitals in the country due to systemic issues has created a dilemma in the minds of psychiatry residents. Therefore, it is necessary to have periodic sensitization programs for psychiatry trainees as well as psychiatrists to learn about changing scenarios in mental health legislation in the past five years.[3] The only discipline of Medicine that carries special significance beyond ethical practice involving beneficence, autonomy, non-maleficence, and justice is psychiatry. This practice and the respect for the rights of a person to bring about optimum mental health outcomes have been legally guided. Forensic psychiatry has started to evolve as a subspecialty of psychiatry.[4] However, are psychiatrists in the country confident in dealing with legal issues evolving in the aftermath of MHA-2017 and imparting this practice to postgraduate trainees? Is clinical practice synchronizing with the legal framework? Are we dealing with the paradox of MHA-2017? Are budding psychiatrists across the country in dilemma with regard to MHA-2017? The response of different states is varied in terms of readiness of infrastructure, the constitution of the State Mental Health Authority (SMHA), the functioning of Mental Health Review Boards (MHRB), and overall dismal application of MHA-2017. Are there hasty translations of Western World rules on the infertile grounds of India? More than four years after passing the act, the current level of functional implementation does not appear to be a healthy indicator for the growth of mental health services in the country. This could provoke lawmakers to bring out the amendments to MHA-2017 to best suit the mental health services and practices of the country. In the absence of functional MHRBs, the practical caveats that may require amendments may include providing electroconvulsive therapy (ECT) to children and use of hospital beds for day-care procedures in psychiatry that include but are not limited to the somatic therapies in psychiatry such as administration of electroconvulsive therapy and repetitive transcranial magnetic stimulation (rTMS). It also includes short-term observation for a few hours in a general hospital following administration of long-acting injectables (LAI) antipsychotics and assessment for the appearance of acute side effects such as post-injection delirium sedation syndrome, and acute dystonia and oculogyric crisis. The other concerns requiring immediate attention for the functioning of MHRB include notifying advance directives, continuing admission under special circumstances, and provision of separate wards for children and women under psychiatry in a general hospital. These amendments could also add the role of MHRBs for adolescents involved in juvenile delinquency, child custody, termination of parental rights, and other related issues.[5] The protection of the rights of a person with mental illness should not be viewed as safeguarding oneself from the practice of psychiatry in the absence of full-fledged implementation of MHA-2017. This could be important for making a provision for the psychiatrist witnessing nonsexual or sexual boundary violation to notify the MHRB in advance, a point not placed in MHA-2017. The spirit of the MHA-2017 also does not clarify the role of the Consultation Liaison Psychiatrist and its effective practice in different departments under general hospital units. Further, the role of the psychiatrist in cases requiring cognizance of other specified acts such as the Prevention of Child Sexual Offense (POCSO) Act, Narcotics and Psychoactive Substances (NDPS) Act, The Rights of Persons with Disabilities (RPwD) Act, Right To Information (RTI) Act, etc. should also be viewed in parallel with MHA-2017. Authors emphasize the opportunity of teaching programs to highlight the gaps in training and implementation of MHA-2017.[6] The absence of functional implementation of MHA-2017 requires the churning of thoughts of stakeholders to amend a few provisions such as the formation of the transitional local hospital review board till formal MHRBs are functional.[7] This letter encourages clinicians and researchers to assess the compliance status of Indian states with MHA-2017 and to provide feasible solutions through systematic scientific research. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Use of long-acting injectable antipsychotics in bipolar affective disorder : conclusions from a psychiatric hospital population

Use of long-acting injectable antipsychotics in bipolar affective disorder : conclusions from a psychiatric hospital population

Factors influencing the prescription of first-generation versus second-generation long-acting injectable antipsychotics: findings from a sample of male prisoners

Factors influencing the prescription of first-generation versus second-generation long-acting injectable antipsychotics: findings from a sample of male prisoners

The place of long-acting injectable antipsychotics in the treatment of schizophrenia

The place of long-acting injectable antipsychotics in the treatment of schizophrenia

Clinical determinants, patterns and outcomes of antipsychotic medication prescribing in the treatment of schizophrenia and schizoaffective disorder: A naturalistic cohort study

BackgroundSchizophrenia affects individuals, families, and systems, with treatment primarily being antipsychotic medications. Long-acting injectable (LAI) antipsychotics are increasingly being used. This study sought to identify predictors of antipsychotic choice, in terms of formulation (LAI vs oral) and class (FGA vs SGA), and clinical outcomes. Methods123 patients who received LAI antipsychotics were diagnosis-matched to patients who received oral antipsychotics. Sociodemographic and clinical factors were extracted from the medical record, including indicators of illness severity. Groups were compared with Chi-Square and t-tests, and logistic regression models were used to identify independent predictors of antipsychotic choice. ResultsPatients that received LAIs had longer admissions, more complex discharges, and greater illness severity; however, there were no differences in readmission rates. Independent predictors of LAIs included younger age, being single, and longer admission. Patients who received FGA LAIs were more likely to use substances and be undomiciled compared to SGA LAIs, with the only predictor being older age. Oral FGAs were more likely than Oral SGAs to be prescribed to older and female patients, as well as those with co-occurring substance use, complex discharges, and longer admissions. ConclusionsIllness severity and duration of illness appear to drive choice of LAI vs. oral antipsychotic medication and FGA vs. SGA. While LAIs were prescribed to patients with greater illness severity, readmission rates were equivalent to those receiving oral medication, supporting the use of LAI in patients with greater illness severity. Rationales for prescribing LAIs to younger patients and FGAs to older patients are discussed.

The Use of Second-Generation Antipsychotics in Patients with Severe Schizophrenia in the Real World: The Role of the Route of Administration and Dosage-A 5-Year Follow-Up.

To assess the impact of the route of administration and doses of second-generation antipsychotics (SGAs) on treatment adherence, hospital admissions, and suicidal behaviour in patients with severe schizophrenia (Clinical Global Impression-Severity-CGI-S ≥ 5), we implemented an observational 5-year follow-up study. A total of 37.5% of the patients on oral antipsychotics (Aps) and 11.5% of those on long-acting injectables (LAIs) abandoned the treatment (p < 0.001). There were no differences in treatment discontinuation between the LAI-AP standard and high-dose groups. A total of 28.1% of the patients on oral Aps had at least one hospitalisation, as well as 13.1% of patients on LAIs (p < 0.001). There were fewer hospitalisations of patients on LAIs in the high-dose group (p < 0.05). Suicide attempts were recorded for 18% of patients on oral Aps but only for 4.6% of patients on LAIs (p < 0.001). No differences were found between the dosage groups on LAIs. Tolerability was good for all Aps and somewhat better for LAIs than oral Aps in terms of side effects (p < 0.05). There were no differences between the standard and high-dose groups. More patients discontinued treatment due to side effects in the oral AP group (p < 0.01). LAI SGA treatment was more effective than oral AP in terms of adherence and treatment outcomes for managing people with severe schizophrenia. Moreover, significant improvements were found that favour high-dose LAI SGA treatment for some of these patients. This study highlights the need to consider LAI antipsychotics and high-dose strategies for patients with severe schizophrenia.

Profile changes in admissions to a psychiatric hospitalisation unit over 15 years (2006–2021), considering the impact of the pandemic caused by SARS-CoV-2

The objective of this current work was to explore whether modification of the diagnostic criteria upon the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the impact of the COVID-19 pandemic had influenced the diagnostic and sociodemographic profiles of mental health admissions. For that purpose, we designed an observational, longitudinal, and retrospective study of the data recorded in the discharge reports of the Brief Hospitalization Unit at Castellon (Spain), between January 2006 and December 2021. The sample consisted of 7,037 participants, with a mean age of 42.1 years. The mean age of admissions, number of women, and presentation of affective disorders, addictions, and dementias all increased significantly during the DSM-5 period. Beyond diagnoses, the reduction in readmissions before the pandemic could be attributed to the use of long-acting injectable antipsychotics. In contrast, the pandemic did not change the percentage of readmissions or the volume of admissions. Also, during the pandemic period, the significant results obtained indicate that the average stay was reduced, affective disorders decreased, and addictions increased. Therefore, clinicians should consider these diagnostic and sociodemographic fluctuations when adapting clinical care, taking into account gender perspective, ageing of patients and increasing of dual and affective disorders.

Cardiovascular risk factors and metabolic syndrome in patients treated with long-acting injectables antipsychotics: a retrospective study.

The present cross-sectional, retrospective study aimed to assess the prevalence of cardiovascular disease (CVD) risk factors and metabolic syndrome in a sample of psychiatric patients treated with long-acting injectable antipsychotics (LAIs). The clinical charts of 120 patients, mainly diagnosed with schizophrenia (30.0%), schizoaffective disorder (15.0%), and bipolar disorder (13.3%) on LAIs therapy - initiated in the period from 2013 to 2019 and lasting at least one year - were retrospectively reviewed and related socio-demographic, clinical and laboratory variables were collected. The 70.8% of patients were treated with first-generation LAIs, and the remaining 29.2% with second-generation LAIs. The overall sample showed low compliance in performing the required exams and evaluations related to CVD risk factors. The prevalence of metabolic syndrome was 30.8%, and, considering specific CVD risk factors, 55% of the total sample reported abdominal obesity, 43.3% arterial hypertension, 41.7% low HDL-cholesterol, 25.8% hypertriglyceridemia, and 20.8% fasting hyperglycemia. Lastly, 6.7% showed prolonged corrected QT (QTc) interval at the ECG. Patients treated with LAIs should be regularly monitored for metabolic changes and CVD risk factors. Metabolic changes rapidly develop after initiating an antipsychotic therapy and these often involve parameters, that can be easily recorded in an outpatient setting (e.g. abdominal obesity and hypertension).

Studies Point to Benefits of Early Treatment With Long-Acting Antipsychotics

Back to table of contents Previous article Next article Clinical & ResearchFull AccessStudies Point to Benefits of Early Treatment With Long-Acting AntipsychoticsNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:23 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.10.39AbstractPatients with schizophrenia who were prescribed oral antipsychotics for less than three years saw greater symptom improvements when switching to long-acting injectable formulations than those who had been taking the oral medications longer.iStock/Rawf8Numerous studies have pointed to the benefits of long-acting injectable antipsychotics (LAIs) at reducing the risk of symptom relapse, hospitalizations, and other adverse outcomes in patients with schizophrenia. A pair of recent studies provide evidence that switching from oral antipsychotics to LAIs within the first two to three years of a diagnosis may provide the greatest benefit.One study involved data collected from Taiwan’s national health insurance on over 19,000 people aged 16 to 65 who had a schizophrenia diagnosis, were taking oral antipsychotics, and were hospitalized for acute psychosis between 2002 and 2005. Among this group, Joni Yu-Hsuan Shao, Ph.D., a professor of biomedical informatics at Taipei Medical University in Taiwan, and colleagues identified 678 patients who were switched from oral antipsychotics to an LAI during hospitalization and who continued to receive the LAI at least 12 months after discharge; 312 received LAIs within three years of their first oral antipsychotic prescription (early stage of treatment), while 366 transitioned following three or more years of oral medication use (late stage of treatment).As described in the Journal of Clinical Psychiatry, each of these patients was matched to a patient of similar age, sex, hospitalization date, and psychiatric comorbidities who continued taking oral antipsychotics following discharge from the hospital. All patients were followed up from their date of hospitalization until the end of the study period (December 31, 2015) or death, whichever came first. During this period the researchers recorded all instances of rehospitalizations (psychiatric or other medical), psychiatric emergency room (ER) visits, or death.Early LAI switchers had the following:37% reduced risk of psychiatric hospitalization.44% reduced risk of any hospitalization.42% reduced risk of a psychiatric ER visit.51% reduced risk of death by any cause.The reductions in adverse health outcomes were not seen in patients who were switched during the late stage of illness; in fact, patients who switched to LAIs in the late stage of treatment had a 34% increased risk of psychiatric rehospitalization during the follow-up period compared with patients who stayed on oral antipsychotics.“These real-world data demonstrated that LAIs in the early stage of treatment of hospitalized patients increased disease control and had long-term benefits,” Shao and colleagues wrote.The other study was published in JAMA Network Open and conducted by Yue Wei, M.P.H., of the University of Hong Kong and colleagues. The investigators used health records data to identify 23,719 individuals diagnosed with schizophrenia between 1993 and 2019 who were prescribed at least one oral and LAI antipsychotic during this time. They compared the health outcomes of these patients during periods while taking oral antipsychotics with periods while taking LAIs.As expected, patients had lower rates of emergency department visits, hospitalizations, and suicide attempts while taking an LAI antipsychotic relative to their time taking an oral antipsychotic. The benefits were more pronounced for those who began taking LAI antipsychotics within two years of a schizophrenia diagnosis; compared with periods they were taking the oral medication, these patients had the following:76% reduced risk of a psychiatric hospitalization.65% reduced risk of any hospitalization.33% reduced risk of an emergency department visit.72% reduced risk of a suicide attempt while on an LAI.Shao said these findings support the critical period hypothesis, which posits that schizophrenia-related deterioration is particularly aggressive in the two to five years after the first episode of psychosis.The Shao study was supported by the Bali Psychiatric Center, Taiwan. The Wei study was supported by The Excellent Young Scientists Fund of the National Natural Science Foundation of China. ■Resources“Long-term Outcomes of Early Use of Long-Acting Injectable Antipsychotics in Schizophrenia”“Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia” ISSUES NewArchived

Practical Guidance for the Use of Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia.

Schizophrenia is a severe mental illness causing a high degree of disability. First- and second-generation antipsychotics (FGAs and SGAs) represent key resources for its acute and long-term management. Since a poor adherence to oral treatments may negatively impact the course of the disorder, long-acting injectable antipsychotics (LAIs) are often used to reduce clinical relapses. Notwithstanding their potential beneficial features, LAIs use in clinical practice remains somewhat hampered by the limited amount of relevant systematic information. This review thus aims at providing a clinical, practical guidance for the use of LAIs in the treatment of schizophrenia. We synthetized main information on indications, dosage, and administration of LAIs approved by the US Food and Drug Administration (FDA) and/or in EU countries, as well as evidence from the most recent systematic reviews and meta-analyses. Currently available information, though heterogeneous, shows that LAIs can prevent relapses and rehospitalizations, improving clinical outcomes and favouring sustained remission among people with schizophrenia. The use of SGA LAIs is supported by more robust evidence than FGA LAIs. Along with their positive impact on the prevention of treatment discontinuation, some LAIs might also enhance individual global functioning and quality of life, without additional adverse events or health-care costs, as compared with oral antipsychotics. Although which LAIs can be considered a first-choice option, as well as their superiority over oral antipsychotics, remain unclear issues, this review offers a comprehensive overview of information available on the use of LAIs for people with schizophrenia, providing clinicians with practical guidance in terms of efficacy and acceptability of single agents. Literature gaps and future research needs are also described.

Therapeutic Drug Monitoring of Long-Acting Injectable Antipsychotics as a Predictor of Relapse in Schizophrenia Spectrum Disorders: A 1-Year Pilot Study.

Long-acting injectable antipsychotics (LAIs) have been shown to reduce acute episodes of schizophrenia spectrum disorders (SSDs). However, breakthrough relapses are frequent, possibly because of underdosing in clinical practice. In this framework, the advantages of therapeutic drug monitoring (TDM) may be overlooked. This study explored the association of low steady-state LAI levels with a higher risk of relapse in SSDs, despite the use of a licensed posology. Forty-eight clinically stable outpatients with SSD underwent LAI-TDM using liquid chromatography-mass spectrometry for routine observational purposes. Baseline anamnestic, pharmacological, and psychometric evaluations compared subjects with "under-range" versus "in-range" LAI serum levels; between-group comparisons for different LAI treatments were also performed. A binary logistic regression explored which baseline factors (age, sex, previous hospitalizations, psychopathology, specific LAI treatment, and underrange serum levels) predicted relapse during the next 12 months. Baseline comparisons did not show significant between-group differences, except for a higher percentage of underrange values in individuals receiving olanzapine pamoate. A total of 10 patients (20.8%) relapsed during the follow-up; only underrange LAI levels predicted the event (odds ratio 0.03, 95% confidence interval 0.01-0.36; P = 0.005). Even if relapse remains as a multifactorial event, LAI-TDM may identify subjects at risk for this negative outcome, thus optimizing antipsychotic maintenance treatment in the context of precision medicine. The finding of underrange LAI plasma levels in real-world practice should prompt adequate monitoring of clinically stable outpatients to identify the early signs of psychopathological deterioration.

Rehospitalization Rates Among Patients with Psychotic Disorders During Covid-19 Pandemic: Oral Versus Long-Acting Injectable Antipsychotics.

The superiority of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics is often emphasized, even in terms of adherence and rehospitaliza-tion rates. As such, LAIs are particularly recommended during the COVID-19 pandemic. The goal of our research was to determine whether there are differences in the number of rehospitalizations in patients treated for schizophrenia, schizophrenia-like disorders, and delusional states (psychotic disorders) with LAI antispychotics versus oral antispychotics. Subjects with schizophrenia, schizophrenia-like disorders and delusional states participated in our retrospective study. 124 subjects were treated with oral anti-psychotics, while 72 received LAIs along with oral antipsychotics. We collected their sociodemographic data and psychiatric history data. Our main outcome measure was the number of rehospitalizations. Statistical analysis showed that the studied groups did not differ according to sociodemographic parameters, except that in the group of patients with LAIs there was a significantly higher percentage of men (65 (52.4) vs 50 (69.4), p=0.029)). Also, the groups do not differ according to the psychiatric history data. There is no difference in the duration of the current hospitalization nor in the composition of the patients, considering the order of the current hospitalization. The difference in the number of rehospitalizations is not significant neither in the first year of follow-up (p=0.144), nor in the second (p=0.142), nor after two years of follow-up (p=0.083). Our research has shown that there is no difference in the number of rehospitalizations in patients with schizophrenia, schizophrenia-like disorders and delusional states, considering whether they take oral antipsychotics or they also take LAIs along with them. We can therefore conclude that it is particularly important to work on improving patient adherence. We must make psychiatrists aware that the pandemic, like other threats, can be our ally in improving adherence ("perceived threat as a health belief").