Use Of Injectable Antipsychotics Research Articles

Racial and Ethnic Disparities in Long-Acting Injectable Antipsychotic Use in a National Sample of Medicare Beneficiaries With Schizophrenia

This cross-sectional study assesses the racial and ethnic disparities in long-acting injectable antipsychotic use in a national sample of Medicare beneficiaries with schizophrenia.

Short communication: Prevalence of long-acting injectable antipsychotic use in Canadian early intervention services for psychosis

The use of long-acting injectable (LAI) antipsychotic drugs for psychotic disorders in Canada has been historically low compared to other jurisdictions despite advantages of LAIs in improving medication adherence and preventing relapse. In response, treatment recommendations were developed in 2013 by the Canadian Consortium for Early Intervention in Psychosis and other Canadian provincial expert groups. The impact of these guidelines needed to be assessed. To document practices in LAI use in early intervention services (EIS) for psychosis, Canadian EIS were surveyed in 2016 (n = 18) and 2020 (n = 12). Trends and descriptive information were examined using repeated cross-sectional survey data. Eight EIS responded to surveys at both time points allowing for longitudinal comparisons. Outcomes of interest included i) LAI use frequency, ii) timing of LAI starts, and iii) factors influencing LAI use. Cross-sectional analysis identified a significant increase in overall LAI usage (24.7% in 2016; 35.1% in 2020). Longitudinal analysis indicated that patients in the second program year saw the greatest increase in LAI use between 2016 and 2020 (25.6% vs. 36.1%), especially among patients under community treatment orders (65.5% vs. 81.5%). Results support increases in LAI use over time, accessibility, awareness, and increasing comfortability among Canadian clinicians.

Long-Acting Injectable Antipsychotic Use in Patients with Schizophrenia and Criminal Justice System Encounters.

Background: Nonadherence to medication is prevalent in persons diagnosed with schizophrenia, thus increasing the likelihood of relapse, poor health outcomes, hospitalization, high treatment costs, and high rates of both violent and non-violent offenses.Objective: To assess the association between long-acting injectable (LAI) antipsychotic use and criminal justice system encounters in patients with schizophrenia or schizoaffective disorder.Methods: This retrospective follow-up study was conducted among patients aged ≥18 years treated for schizophrenia or schizoaffective disorder at a community mental health center in Akron, Ohio, between January 1, 2010, and June 15, 2016. The incidence of criminal justice system encounters at 6 months, 1 year, and 2 years pre- versus post-LAI antipsychotic initiation was assessed. A subanalysis was conducted for individuals with a history of prior arrest.Results: Overall, the risk ratio (RR) of having an encounter with the criminal justice system was significantly lower for patients treated with LAI antipsychotics 1 year after initiation of treatment compared with a similar time period prior to initiation (RR [95% confidence interval (CI)]: 0.74 [0.59–0.93]; P<0.01) and 2 years (0.74 [0.62–0.88]; P<0.0001). Statistically significant reductions in criminal justice system encounters after treatment than before treatment were observed in the once-monthly paliperidone palmitate (PP1M) cohort. The incidence of arrests was lower in the 6-month (27 vs 85 arrests), 1-year (46 vs 132 arrests) and 2-year (88 vs 196 arrests) periods post-index LAI medication than in the corresponding periods pre-index LAI medication among individuals with a history of prior arrest.Conclusions: Patients with schizophrenia or schizoaffective disorder who were initiated on a LAI antipsychotic medication, specifically PP1M, were less likely to have an encounter with the criminal justice system compared with a similar time period before the initiation of LAI treatment.

Long-Acting Injectable Antipsychotic Use During Pregnancy: A Brief Review and Concise Guide for Clinicians.

Women with psychotic and mood disorders are at greater risk of symptoms during pregnancy, but some clinicians avoid use of LAIs in these patients due to safety concerns. This article highlights points to consider in the decision-making process.

Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia

Long-acting injectable antipsychotics (LAIs) can potentially reduce hospitalization risk by enhancing medication adherence but are rarely considered for early-phase schizophrenia treatment. To determine whether encouraging use of a LAI compared with usual care delays the time to first hospitalization with patients with early-phase illness. The Prevention of Relapse in Schizophrenia (PRELAPSE) trial was cluster randomized with a follow-up duration of 2 years. The study began in December 2014, was completed in March 2019, and was conducted in 39 mental health centers in 19 US states. Site randomization assigned 19 clinics to encourage treatment with long-acting aripiprazole monohydrate (aripiprazole once monthly [AOM] condition) and 20 to provide treatment as usual (clinician's choice [CC] condition). Participant eligibility criteria included (1) schizophrenia diagnosis confirmed by a structured clinical interview, (2) fewer than 5 years of lifetime antipsychotic use, and (3) age 18 to 35 years. The AOM sites identified 576 potentially eligible participants, of whom 234 (40.6%) enrolled; CC sites identified 685 potentially eligible participants, of whom 255 (37.2%) enrolled. There were no restrictions on treatment at CC sites (including using LAIs) or at AOM sites with the exception that aripiprazole monohydrate had to be prescribed within US Food and Drug Administration-approved guidelines. The primary outcome was time to first psychiatric hospitalization based on participant interviews every 2 months, the service use resource form administered every 4 months, and other sources (eg, health records) as available. Potential events were adjudicated by an independent committee masked to treatment assignment. The 489 participants (368 men [75.3%]) had a mean (SD) age of 25.2 (4.2) years and 225 (46.0%) had 1 year or less lifetime antipsychotic use. Fifty-two AOM (22%) and 91 CC participants (36%) had at least 1 hospitalization. The mean survival time until first hospitalization was 613.7 days (95% CI, 582.3-645.1 days) for AOM participants and 530.6 days (95% CI, 497.3-563.9 days) for CC participants. For time to first hospitalization, the hazard ratio was 0.56 (95% CI, 0.34- 0.92; P = .02), favoring AOM. Survival probabilities were 0.73 (95% CI, 0.65-0.83) for AOM participants and 0.58 (95% CI, 0.50-0.67) for CC participants. The number needed to treat to prevent 1 additional hospitalization was 7 participants treated with AOM compared with CC. Long-acting injectable antipsychotic use by patients with early-phase schizophrenia can significantly delay time to hospitalization, a personally and economically important outcome. Clinicians should more broadly consider LAI treatment for patients with early-phase illness. ClinicalTrials.gov Identifier: NCT02360319.

Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region.

Patterns of clinical use of long-acting injectable (LAI) antipsychotic drugs in many countries, especially in Asia, for treatment of patients diagnosed with chronic psychotic disorders including schizophrenia are not well established. Within an extensive research consortium, we evaluated prescription rates for first- (FGA) and second-generation antipsychotic (SGA) LAI drugs and their clinical correlates among 3557 subjects diagnosed with schizophrenia across 15 Asian countries and region. Overall, an average of 17.9% (638/3557; range: 0.0%-44.9%) of treated subjects were prescribed LAI antipsychotics. Those given LAI vs orally administered agents were significantly older, had multiple hospitalizations, received multiple antipsychotics more often, at 32.4% higher doses, were more likely to manifest disorganized behavior or aggression, had somewhat superior psychosocial functioning and less negative symptoms, but were more likely to be hospitalized, with higher BMI, and more tremor. Being prescribed an FGA vs SGA LAI agent was associated with male sex, aggression, disorganization, hospitalization, multiple antipsychotics, higher doses, with similar risks of adverse neurological or metabolic effects. Rates of use of LAI antipsychotic drugs to treat patients diagnosed with schizophrenia varied by more than 40-fold among Asian countries and given to an average of 17.9% of treated schizophrenia patients. We identified the differences in the clinical profiles and treatment characteristics of patients who were receiving FGA-LAI and SGA-LAI medications. These findings behoove clinicians to be mindful when evaluating patients' need to be on LAI antipsychotics amidst multifaceted considerations, especially downstream adverse events such as metabolic and extrapyramidal side effects.

Trends in the Use of Long-Acting Injectable Antipsychotics in the Province of Manitoba, Canada.

Long-acting injectable antipsychotics (LAIAs) have advantages over oral antipsychotics but are not widely used. We aimed to evaluate the impact of market entry of second-generation LAIAs on prescribing trends. We used administrative health databases to describe trends in LAIA use from 1995 to 2015 in the Canadian province of Manitoba. Age- and sex-specific incident and prevalent use were determined using prescription dispensation records for the entire population. We used interrupted time series analysis with Poisson regression to estimate change in LAIA use attributable to the market entry of the second-generation LAIA risperidone. We observed 3380 prevalent LAIA users and 2375 incident users in our cohort. Long-acting injectable antipsychotic use was higher in males. Incidence proportions declined from 21.5 users per 100,000 in 1996 to 4.8 in 2004 and then climbed to 14.7 by 2015. First-generation LAIA use peaked at 94.6 prevalent users per 100,000 in 1998 but fell to 40.9 in 2015. Long-acting injectable antipsychotic use increased 1.4% per quarter after the market entry of risperidone long-acting injectable. Risperidone risperidone long-acting injectable market entry had a positive impact on LAIA prescribing.

Understanding gaps in perception surrounding long-acting injectable antipsychotic use within the forensic system

In this paper, a finite-time tracking control problem is considered for a class of pure-feedback nonlinear systems with event-triggered strategy. The implicit function theorem and the mean value theorem are used to transform the pure-feedback nonlinear systems into strict feedback nonlinear systems. The neural network is adopted to approximate the unknown function and the tracking error is limited to a pre-given boundary by prescribed performance at a finite time. In addition, an improved event-triggered control strategy is proposed to obtain a larger threshold, and also the proposed controller can avoid the Zeno-behavior. Based on Lyapunov stability theory, the adaptive neural network controller can ensure that all the signals in the closed-loop system are uniformly ultimately bounded. Finally, the feasibility of this control scheme is proved by simulation.

Risk of Hospitalization Due to Medication Nonadherence Identified Through EMRs of Patients With Psychosis.

This study examined whether outpatients with a psychotic disorder who are at risk of hospitalization can be identified by using data from electronic medical records (EMRs). Data from EMRs of outpatients enrolled in two clinics for treatment of psychotic disorders were abstracted. Monthly data were collected for 75 patients over two years. The study examined the association of medication nonadherence, substance use, participation in psychiatric rehabilitation, and long-acting injectable antipsychotic use in any given month with the risk of hospitalization in the subsequent month by using generalized estimating equations. The only variable found to increase the relative risk of future hospitalization was recorded medication nonadherence (adjusted relative risk=7.19, p<.001). Results suggest that recording medication nonadherence in EMRs is feasible and that these data may be used to identify patients at high risk of future hospitalization, who may require more intensive intervention.

Is the use of long-acting injectable antipsychotic extended in the outpatient treatment of bipolar disorder? A brief description

AimsObtain and analyze information on treatment guidelines, with particular emphasis on the use of antipsychotics, in patients diagnosed with bipolar disorder I and bipolar disorder II who are treated at a mental health center in a district of Madrid (Spain) under the conditions of habitual clinical practice.Then, compare with recently published literature.MethodsWe performed a descriptive study of a sample of 100 patients diagnosed with bipolar disorder (type I and type II) at any stage of the disease who receive regular treatment in a mental health center in a district of Madrid. Information regarding the treatment used, especially the use of antipsychotics (either in a single therapy or in combination with other drugs such as mood stabilizers, antidepressants, hypnotics or anxiolytics), was collected retrospectively from the data obtained from the medical record.ResultsNinety-four percent of patients are taking mood stabilizer treatment (68% lithium, 24% valproate, 1% and 1% carbamazepine and lamotrigine). Four percent take lithium and valproate in combination. Forty-eight percent of patients are taking some antipsychotic (atypical about 90%). Of these, only 10% in injectable form, and 5% take both oral and injectable antipsychotics.ConclusionsThe diminished use of injectable antipsychotics, well below recent publications, draws the attention. You can probably explain this low proportion of injectable medication because we are generally dealing with stable patients with a long-term disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.