Long-acting Antipsychotic Medication Research Articles

Treatment of schizophrenia with long-acting fluphenazine, haloperidol, or risperidone.

Objective: This study compares 3 cohorts of patients with schizophrenia before, during, and after initiating treatment with fluphenazine decanoate (FD), haloperidol decanoate (HD), or long-acting injectable risperidone (LAR). Methods: Administrative data are analyzed from California Medicaid (Medi-Cal) beneficiaries with schizophrenia who initiated FD, HD, or LAR treatment. Patients were required to have been continuously enrolled in Medi-Cal for 180 days before and 180 days after the start of the new episode of long-acting antipsychotic therapy. Results: There were few demographic and clinical differences among patients initiating FD, HD, and LAR. During the 180 days before starting long-acting injections, most patients initiating FD (53.5%), HD (58.5%), and LAR (61.2%) received oral antipsychotic medications for <80% of the days in this period (medication possession ratio: <0.80). The mean duration of depot treatment episodes was 58.3 days (SD = 53.6) for FD, 71.7 days (SD = 56.4) for HD, and 60.6 days (SD = 48.8) for LAR (F = 18.3, df = 2, 2694, P < .0001, HD > FD). Few patients who started on FD (5.4%), HD (9.7%), or LAR (2.6%) continued for at least 180 days. Most patients in each group (FD [77.4%], HD [78.9%], and LAR [75.5%]) received oral antipsychotic medications during the 45 days after discontinuing long-acting injections. Coprescription with antidepressants, mood stabilizers, and benzodiazepines was common. Conclusions: Patients treated with long-acting antipsychotic injections tend to have complex pharmacological regimens and recent medication nonadherence. A great majority of patients initiating long-acting antipsychotic medications discontinue use within the first few months of treatment.

Challenging perceptions of long-acting injectable antipsychotic medications

Eddie Urquhart reviews the problems of patient non-compliance and assesses the benefits and perceived problems associated with the use of long-acting antipsychotic medications

Ethical use of long-acting medications in the treatment of severe and persistent mental illnesses

Mental illnesses are prevalent, cause great suffering, and are burdensome to society. Traditional “depot” antipsychotic agents are used to treat the most severely and persistently mentally ill individuals. They will soon be joined by new atypical antipsychotic medications in long-acting formulations. These long-acting medications pose special ethical issues, but may greatly benefit some people who suffer from severe and persistent mental illnesses. The objective of the current report is to highlight ethical considerations related to the use of long-acting antipsychotic medications. An analysis centering on the ethical concepts of voluntarism, beneficence, and justice is performed, integrating relevant empirical evidence and bioethics principles. Two main conceptual issues related to constraints upon voluntarism and coercion exist. Careful examination of ethically important empirical evidence suggests that voluntarism may not be perceived as an issue for some persons receiving depot antipsychotic medications. A favorable balance of benefits and risks has been documented for some individuals with severe and persistent mental illnesses. Access to care, innovative treatments, and long-acting antipsychotic medications may arise as an issue of justice and nondiscrimination in the care of mental illness. Considerations of justice indicate that long-acting medications may need to be used more frequently and earlier in the course of severe and persistent mental illness for select patients. We conclude that great care should be given to ethically important issues surrounding voluntarism, beneficent care, and equitable access to innovative psychiatric treatments, especially for persons who carry the burden of stigma as well as severe and persistent mental illness.

Long-acting antipsychotic medication, restraint and treatment in the management of acute psychosis

Long-acting antipsychotic medication, restraint and treatment in the management of acute psychosis

Long-acting antipsychotic medication, restraint and treatment in the management of acute psychosis.

Zuclopenthixol acetate (ZA) is the first parenteral antipsychotic medication introduced for clinical use in the treatment of aggression and agitation that has a relatively prolonged duration of action. The aim of this paper is to explore a number of important ethical and clinical issues that are raised by the use of this novel therapeutic formulation. Relevant literature is explored and several issues are identified from which arguments for and against the use of medication of this type are raised. These issues are considered in general and with the use of a number of stylised clinical scenarios. The use of long-acting antipsychotic medication is complicated by its impact upon patient autonomy, by considerations of informed consent and by the need to provide justice to all patients and staff in a psychiatric treatment setting. The use of ZA in the emergency treatment of psychotic patients may only be justified under specific clinical circumstances and its use is not appropriate as routine chemical restraint. Zuclopenthixol acetate is a novel and potentially useful treatment alternative in the acutely disturbed patient. Institutions in which ZA is used in emergency settings should develop protocols to guide clinicians in its appropriate use and provide monitoring.

Treatment of Delusional Parasitoses-Reply

In Reply. —The suggestion by Dr Clayton and others regarding the use of EPS-sparing antipsychotic drugs for the treatment of delusions of parasitosis is a good idea that needs to be evaluated clinically. If these medications do work well for delusions of parasitosis, they can certainly replace pimozide as the treatment of choice. However, these EPS-sparing antipsychotic medications may not work as well as pimozide. This possibility arises because there is something unique about pimozide compared with the other antipsychotic agents, and this uniqueness may be responsible for pimozide's particular efficacy for this condition: pimozide has great efficacy for formication (crawling, biting, and stinging sensations). 1 In Europe, it was found that there are only 2 antipsychotic medications that have profound effect on formication: one is pimozide and the other is flusipilene, a long-acting antipsychotic medication not available in the United States. 2 Both of these medications are unique in that they

The Efficacy of Antipsychotic Drugs and Family Therapies in the Maintenance Treatment of Schizophrenia

The efficacy of antipsychotic drugs in both the short-term and long-term treatment of schizophrenia has been clearly demonstrated. Long-acting injectable drugs are particularly useful because of the clarity they provide about the patient's receipt of medication. The clinician can better understand the circumstances surrounding a relapse in a patient receiving long-acting antipsychotic medication because there is no uncertainty about drug compliance. Approaches to psychosocial therapy that emphasize education and involvement of family members in the treatment process also show particular promise for long-term maintenance care of schizophrenic patients. Three models of family therapy are described, and their impact on subsequent relapse rates is reviewed. Although few studies have systematically explored the interaction of drug and psychosocial treatments, the available data suggest that this treatment strategy is effective in both preventing relapse and reducing psychotic symptomatology.