Long-acting Injectable Antipsychotics Research Articles

Use of Long-Acting Injectable Antipsychotics in Inpatients with Schizophrenia Spectrum Disorder in an Academic Psychiatric Hospital in Switzerland.

Long-acting injectable antipsychotics (LAIs) offer many benefits to patients with schizophrenia spectrum disorder (SSD). They are used with very different frequencies due to questions of eligibility or patients and prescribers’ attitudes towards LAI use. We assessed the prescribing rates of LAIs in a large academic psychiatric hospital with a public service mandate in Switzerland and compared them with other countries and health care systems. To our knowledge, this study is the first to investigate inpatient LAI use in Europe. Medical records of all patients diagnosed with SSD discharged from the Clinic of Adult Psychiatry of the University Hospital of Psychiatry Zurich over a 12 month period from January to December 2019 were evaluated regarding the prescribed antipsychotics at the time of discharge. The rates of use of LAIs among all patients and among patients receiving LAI-eligible antipsychotic substances were assessed retrospectively. We assessed records of 885 patients with SSD. Among all cases, 13.9% received an LAI. Among patients who received antipsychotic medication that was eligible for LAI use (n = 434), 28.1% received an agent as an LAI. LAI use included paliperidone palmitate (69.9%), aripiprazole monohydrate (14.6%), risperidone (4.9%) and first-generation LAIs (9.8%). Compared to international frequencies of LAI administration, the prescription rate of LAIs in SSD patients was low. Further studies will evaluate patient- and prescriber-related reasons for this low rate.

Switch from Olanzapine Long-Acting Injectable to its Oral Equivalent during COVID-19 Pandemic: a Real World Observational Study

Schizophrenia is a psychiatric condition with chronic evolution, one of the most disabling diseases. The main cause for the disease’s progression is considered to be the lack of compliance with the treatment. Long-acting injectable antipsychotics (LAIs) are an important treatment option for patients with schizophrenia. Olanzapine long-acting injection (OLZ-LAI) is a pamoate monohydrate salt of olanzapine that is administered by deep intramuscular gluteal injection. The aim of this paper is to report the effects of a sudden and unplanned switch from olanzapine long-acting injectable to oral olanzapine in remitted patients with schizophrenia due to restrictions caused by the COVID-19 pandemic. An observational study conducted in the Clinical Hospital of Psychiatry and Neurology of Brasov, Romania between April 2020 and March 2021. 27 patients with OLZ-LAI were entered into the study. Of 27 cases, 21 patients preferred to be switched to oral olanzapine (77.77%). Only 6 patients continued with the long-acting formulation. The main reason for the initiation of olanzapine pamoate in all the patients was non-adherence to oral medication (80.95%), and the mean age of starting LAI olanzapine was 36.42 years (SD ± 10.09). Within the following 12 months after switching from olanzapine LAI to OA, 15 patients (71.42%) relapsed, and 12 were admitted to the emergency psychiatric unit. The COVID-19 pandemic has brought multiple disservices to current medical practice. Sudden and unplanned switch from olanzapine long-acting formulation to oral olanzapine was followed by the high rate of relapse in remitted schizophrenia.

Attitudes Toward Long-Acting Injectable Antipsychotics among Schizophrenia Patients in Southern Thailand: A Multihospital-Based Cross- Sectional Survey

Objective: To identify the attitudes toward long-acting injectable antipsychotics (LAIs) among schizophrenia atthree psychiatric outpatient clinics in Southern Thailand from February to April 2021.Materials and Methods: A study was conducted at three psychiatric outpatient clinics. All patients, who met the criteria of having schizophrenia based on ICD-10 criteria, aged 20-60 years were included. The questionnaires utilized were:1) Demographic information, 2) Profile of schizophrenia disorder, and 3) Attitude, knowledge, and satisfaction towards LAIs. All data were analyzed using descriptive statistics.Results: There were 259 participants who completed the questionnaires. From the participants, 39% had a history of being treated with LAIs. A quarter of them felt LAIs made them feel stigmatized (26.3%), that they lost autonomy (24.7%), and embarrassed (16.6%). The reasons for refusing to receive LAIs were not fear of needles or pain at the injection site (49%), but rather that LAIs had more adverse effects than oral medications (47.9%). Half of them (51.8%) knew that they must continue to use LAIs, even though their symptoms had improved as LAIs played an important role by improving their symptoms (68.8%), and preventing relapse (51.8%). They were satisfied about having been involved in the decision making of using LAIs for their treatment (63.6%), having information on therisk-benefits from LAIs provided to them (72.3%), and the cost of LAIs (75.2%).Conclusion: Before deciding to prescribe LAIs, we should ensure that all patients receive information about the risks, and benefits of LAIs, boosting acceptance for this formulation and mitigating concerns about patient autonomy reduction and stigmatization.

Weekly Supervised Administration of Oral Antipsychotics: An Alternative to Long-Acting Injections?

Maintenance of response in schizophrenia is largely dependent on compliance with antipsychotic treatment. When people with schizophrenia are responsible for their own treatment, partial or non-adherence is common and usually results in relapse. Assured compliance with antipsychotic treatment is possible when long-acting injectable antipsychotics are given by healthcare staff, but some patients may not consent to treatment for a variety of reasons. An alternative to long-acting injections is the use of supervised oral administration of long-acting antipsychotics. This method assures compliance with prescribed regimens without the need for injections. To be suitable for once-weekly administrationas an oral formulation, an antipsychotic needs to have a sufficiently long duration of action and to be well tolerated in high doses. There is evidence that weekly oral administration of either pimozide or penfluridol is effective and well tolerated in the treatment of schizophrenia. Other drugs potentially suitable for once-weekly oral administration include aripiprazole, brexpiprazole and cariprazine.

Drug Use Pattern of Long-Acting Injectable Antipsychotics on Outpatient of National Mental Hospital During the Last 10 Years

Drug Use Pattern of Long-Acting Injectable Antipsychotics on Outpatient of National Mental Hospital During the Last 10 Years

Systematic literature review of schizophrenia clinical practice guidelines on acute and maintenance management with antipsychotics

Clinical practice guidelines (CPGs) translate evidence into recommendations to improve patient care and outcomes. To provide an overview of schizophrenia CPGs, we conducted a systematic literature review of English-language CPGs and synthesized current recommendations for the acute and maintenance management with antipsychotics. Searches for schizophrenia CPGs were conducted in MEDLINE/Embase from 1/1/2004–12/19/2019 and in guideline websites until 06/01/2020. Of 19 CPGs, 17 (89.5%) commented on first-episode schizophrenia (FES), with all recommending antipsychotic monotherapy, but without agreement on preferred antipsychotic. Of 18 CPGs commenting on maintenance therapy, 10 (55.6%) made no recommendations on the appropriate maximum duration of maintenance therapy, noting instead individualization of care. Eighteen (94.7%) CPGs commented on long-acting injectable antipsychotics (LAIs), mainly in cases of nonadherence (77.8%), maintenance care (72.2%), or patient preference (66.7%), with 5 (27.8%) CPGs recommending LAIs for FES. For treatment-resistant schizophrenia, 15/15 CPGs recommended clozapine. Only 7/19 (38.8%) CPGs included a treatment algorithm.

Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach.

This study aims to describe the utilization patterns of antipsychotic (AP) medication in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP. Based on medico-administrative information on patients living in Quebec (Canada), this retrospective cohort study included 6444 patients with a previous diagnosis of SCZ initiating or reinitiating AP medication between January 1, 2012, and December 31, 2014, with continuous coverage by public drug insurance. For each day of follow-up (1092days), patient was either exposed to one of the chosen categories of APs, or to none. This patient's sequence of AP exposure overtime has been referred to as the "antipsychotic utilization trajectory". These trajectories were analyzed using a State Sequence Analysis, an innovative approach which provides useful visual information on the continuation and discontinuation patterns of use over time. Clozapine and long-acting injectable second-generation APs had the best continuation and discontinuation patterns over 3years among all other groups, including less switching of APs, while oral first-generation APs had the poorest patterns. These findings were comparable among incident and non-incident cohorts. Oral second-generation antipsychotics, excluding clozapine, had a poorer continuation and discontinuation pattern than long-acting injectable antipsychotics. State Sequence Analysis provides a clear representation of treatment adherence in comparison with dichotomous indicators of adherence or discontinuation. Consequently, this innovative method has shed light on the impact of the AP chosen to initiate or reinitiate treatment in SCZ, which has been identified as a key factor for long-term treatment continuation and discontinuation.

Development and Evaluation of a Web-Based Educational Toolkit on the Knowledge, Attitudes, and Practices of Psychiatric Prescribers Regarding Long-Acting Injectable Antipsychotics.

Long-acting injectable antipsychotics (LAIs) are unique and effective pharmacological treatment options for schizophrenia that are underutilized in clinical practice. Research surrounding prescriber barriers to the underuse of LAIs are limited to a few seminal studies which identified psychiatric prescriber barriers to the use of LAIs as knowledge deficits, uninformed attitudes, and poor prescribing practices. There is a gap in the literature regarding effective educational interventions to target the identified psychiatric prescriber barriers to the use of LAIs. The study aimed to develop a web-based educational toolkit that would positively affect the knowledge, attitudes, and practices of psychiatric prescribers regarding LAIs. A one-group, before and after design with a convenience, purposive sample of 17 psychiatric prescribers to assess the knowledge, attitudes, and practices (KAP) using a 20-item KAP questionnaire before and after a presentation of a web-based educational toolkit about LAIs was chosen. The web-based educational toolkit slightly improved the total and three subscales KAP scores of psychiatric prescribers. However, only the difference in total KAP scores was found to be statistically significant. The developed and evaluated web-based educational toolkit could provide a foundation for positive change to psychiatric prescribers' KAP regarding LAIs.

Combination With Long-Acting Injectable Antipsychotics and Utilization of Nonstandard Formulations as Compliance Enhancing Methods for Clozapine Users: A Systematic Review and A Case Series.

Combining clozapine with a long-acting injectable antipsychotic (LAI) or using different, nonstandard formulations of the compound may improve treatment outcomes. We aimed to investigate the utility of the clozapine-LAI combination and different formulations of clozapine for compliance problems of clozapine treatment, and to describe a case series on the combined treatment. We conducted a PubMed search with no date restriction. The number and length of hospitalizations, the results of clinical scales, and adverse events were recorded. We also present a case series of 18 patients using the clozapine-LAI combination. Data were collected from the medical charts and electronic records. We extracted 9 records describing the use of the clozapine-LAI combination. The case reports and mirror-image studies showed a significant reduction in the number of hospitalizations, length of hospital stays, and number of visits to the emergency department on the combined treatment with no serious adverse events. We included 11 articles for clozapine formulations. The case reports and retrospective data suggested that short-acting intramuscular clozapine was often well tolerated and resulted in an increased acceptance of oral clozapine in the acute phase of illness. In our case series, illness severity and the number of hospitalization per year significantly decreased after the combined treatment, besides a significant improvement in the functioning scores. Hyperprolactinemia and extrapyramidal side effects were reported due to concomitant LAIs. Despite the encouraging evidence, the present data are preliminary and mostly based on retrospective studies, and oral-dissolving tablets or oral liquid formulations of clozapine have insufficient evidence for clinical practice. Well-designed, controlled, follow-up studies are needed for both clozapine-LAI combination and different formulations of clozapine.

Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis

Schizophrenia is a common, severe, and usually chronic disorder. Maintenance treatment with antipsychotic drugs can prevent relapse but also causes side-effects. We aimed to compare the efficacy and tolerability of antipsychotics as maintenance treatment for non-treatment resistant patients with schizophrenia. In this systematic review and network meta-analysis, we searched, without language restrictions, the Cochrane Schizophrenia Group's specialised register between database inception and April 27, 2020, PubMed from April 1, 2020, to Jan 15, 2021, and the lists of included studies from related systematic reviews. We included randomised controlled trials (RCTs; ≥12 weeks of follow-up) that recruited adult participants with schizophrenia or schizoaffective disorder with stable symptoms who were treated with antipsychotics (monotherapy; oral or long-acting injectable) or placebo. We excluded RCTs of participants with specific comorbidities or treatment resistance. In duplicate, two authors independently selected eligible RCTs and extracted aggregate data. The primary outcome was the number of participants who relapsed and was analysed by random-effects, Bayesian network meta-analyses. The study was registered on PROSPERO, CRD42016049022. We identified 4157 references through our search, from which 501 references on 127 RCTs of 32 antipsychotics (comprising 18 152 participants) were included. 100 studies including 16 812 participants and 30 antipsychotics contributed to our network meta-analysis of the primary outcome. All antipsychotics had risk ratios (RRs) less than 1·00 when compared with placebo for relapse prevention and almost all had 95% credible intervals (CrIs) excluding no effect. RRs ranged from 0·20 (95% CrI 0·05-0·41) for paliperidone oral to 0·65 (0·16-1·14) for cariprazine oral (moderate-to-low confidence in estimates). Generally, we interpret that there was no clear evidence for the superiority of specific antipsychotics in terms of relapse prevention because most comparisons between antipsychotics included a probability of no difference. As we found no clear differences between antipsychotics for relapse prevention, we conclude that the choice of antipsychotic for maintenance treatment should be guided mainly by their tolerability. The German Ministry of Education and Research and Oxford Health Biomedical Research Centre.

Preventing relapse in schizophrenia needs better evidence

Given the considerable contribution of schizophrenia spectrum disorders to the global burden of disease, implementing evidence-based treatments is a global health priority. 1 GBD 2017 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 1789-1858 Google Scholar , 2 Patel V Saxena S Lund C et al. The Lancet Commission on global mental health and sustainable development. Lancet. 2018; 392: 1553-1598 Google Scholar Building on a previous network meta-analysis of randomised trials of antipsychotics for acute symptoms of schizophrenia, 3 Huhn M Nikolakopoulou A Schneider-Thoma J et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019; 394: 939-951 Google Scholar Johannes Schneider-Thoma and colleagues 4 Schneider-Thoma J Chalkou K Dörries C et al. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet. 2022; 399: 824-836 Google Scholar assessed 32 oral and long-acting injectable antipsychotics for 14 different efficacy and tolerability outcomes in a systematic review and network meta-analysis published in The Lancet. The primary outcome was the number of participants who relapsed after clinical stabilisation. 4 Schneider-Thoma J Chalkou K Dörries C et al. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet. 2022; 399: 824-836 Google Scholar The authors found that, for the prevention of relapse, most antipsychotics were superior to placebo, but there were no clinically relevant differences between antipsychotics, as most comparisons included a probability of no difference. Comparing side-effects between antipsychotics generally confirmed findings from trials of acute phase schizophrenia, showing the highest risk of extrapyramidal effects for first-generation antipsychotics, weight gain for second-generation antipsychotics, and hyperprolactinaemia for paliperidone and risperidone. However, for some important side-effects, such as tardive dyskinesia, imprecise results prevented clinical implications from being drawn. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysisAs we found no clear differences between antipsychotics for relapse prevention, we conclude that the choice of antipsychotic for maintenance treatment should be guided mainly by their tolerability. Full-Text PDF

Evaluation of patient satisfaction and perceptions of a long-acting injectable antipsychotic medication administration service in a community-based pharmacy during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic, restrictions, and social distancing requirements for medical offices reduced scheduling availability and increased virtual televisits by providers. COVID-19 restrictions created a barrier to health care access for patients who are being administered long-acting injectable antipsychotics (LAIs) in an already vulnerable population. ObjectiveTo describe an LAI medication administration service at a community-based pharmacy during the COVID-19 pandemic, to evaluate patient satisfaction with the administration of LAIs by a pharmacist service in a community-based pharmacy during the COVID-19 pandemic, and to compare the patient’s perceptions of receiving LAIs in a community-based pharmacy with those in another setting previously used for medication administration. Practice descriptionIndependent full-service community-based pharmacy. Practice innovationImplementation of an LAI administration service after an increase in provider referrals of patients to the community-based pharmacy during the COVID-19 pandemic. Evaluation methodsA 4-month prospective convenience sample study conducted to evaluate the LAI medication administration service. The survey containing 32 questions was adapted with permission from a previous survey administered in a large grocery store chain to a similar population. Survey results were reported using descriptive statistics. ResultsEleven patients completed the survey. A total of 82% of patients strongly agreed that they felt comfortable with receiving this service at the community-based pharmacy and were satisfied with the privacy during the service. Seventy-one percent of patients who received this service elsewhere strongly agreed the LAI medication administration service was more convenient than a similar service received elsewhere, yet only 18% of patients strongly agreed that the community-based pharmacy was near their work or home. ConclusionA medication administration service for LAIs was developed in a community-based pharmacy, and patients were satisfied with the service. Further research needs to be completed to evaluate health outcomes and financial implications of this service for the patient and health care system.

Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment.

Introduction: Atypical antipsychotics have numerous benefits compared to conventional ones in respect to the possible adverse effects. However, like the other ones, they may induce direct cardiovascular alterations, probably through the apoptotic effect of dopamine receptor D2 (DRD2) blockade. The main objective of the study was to assess the cardiac ejection fraction (EF) using transthoracic speckle tracking echocardiography (TSTE) in patients treated with long-acting injectable (LAI) atypical antipsychotics. Patients, Materials and Methods: This cross-sectional study was conducted on 123 patients with schizophrenia or schizoaffective disorder divided in four samples according to their treatment: Aripiprazole, Olanzapine, Paliperidone and Risperidone. We analyzed socio-demographic data, the intensity of psychiatric symptoms, the duration of psychosis and of LAI treatment, and the cardiac EF measured with TSTE. Results: We found no statistically significant differences between the four antipsychotics regarding the values of the EF. Nevertheless, we observed a trend indicating that patients treated with an antipsychotic associated with a lower affinity for the DRD2, such as Olanzapine, have higher EF values than patients treated with antipsychotics with a stronger binding to the DRD2, such as Paliperidone and Risperidone. Patients receiving Aripiprazole, which has the strongest affinity for the DRD2 from all four antipsychotics but is also a partial DRD2 agonist, display higher EF values than those on Paliperidone and Risperidone. Conclusions: Antipsychotics with a lower affinity for the DRD2 or a partial agonism for it may be associated with higher EF. Cardiac monitoring should be performed periodically in patients on LAI antipsychotic therapy.

The post COVID-19 healthcare landscape and the use of long-acting injectable antipsychotics for individuals with schizophrenia and bipolar I disorder: the importance of an integrated collaborative-care approach

BackgroundLong-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I.MethodsTen experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search.ResultsIndividuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic.ConclusionsThe COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.

Time to rehospitalization in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics or oral antipsychotics

Background:Involuntarily hospitalized individuals suffering from schizophrenia often have a poorer prognosis after discharge.Objective:This study aimed to analyze time to rehospitalization within 6 months of discharge in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs). In addition, temporal trends in LAI use at discharge were explored.Methods:Involuntarily hospitalized individuals suffering from schizophrenia discharged from the study hospital between 2006 and 2019 (n = 806) were included in the analysis. Survival analysis was used to compare time to rehospitalization within 6 months of discharge between individuals discharged on LAIs and OAPs, and between first-generation antipsychotic (FGA) LAIs and second-generation antipsychotic (SGA) LAIs. The Cochran–Armitage trend test was used to test whether a temporal trend existed for LAIs use at discharge during the study period.Results:The LAIs group (n = 231) had a significantly lower rate of rehospitalization and a significantly longer time to rehospitalization than the OAPs group (n = 575). Rehospitalization rate and time to rehospitalization were not significantly different between individuals discharged on FGA-LAIs and SGA-LAIs. LAIs use at discharge grew significantly from 16.77% in 2006 to 50.00% in 2019 (Z = 6.81, p < 0.0001). Among all LAIs, only use of SGA-LAIs at discharge increased significantly (Z = 5.74, p < 0.0001), but not FGA-LAIs.Conclusions:LAIs were superior to OAPs in preventing rehospitalization. However, SGA-LAIs were comparable with FGA-LAIs in reducing rehospitalization risk. Use of LAIs increased significantly in discharged involuntarily hospitalized individuals during the study period, especially SGA-LAIs.

Symposium

Long acting injectables antipsychotics (LAIs) preparations were introduced for the first time in 1960s for management of schizophrenia. Over the years, many LAIs have been introduced. A recent meta-analysis of prospective and retrospective studies evaluating the effectiveness of LAIs vis-à-vis oral antipsychotics in patients with schizophrenia have demonstrated superiority of LAIs over oral antipsychotics in reducing rehospitalization rates, illness severity/chronicity, have lower all cause discontinuation rates and improved medication adherence. However, despite all these findings, oral antipsychotics form the bulk of the prescriptions for patients with psychotic disorders. The prescription rates for LAIs by the psychiatrists’ all across the World show wide variation with rates ranging from 6% to 80%. Several factors influence the prescription of LAI’s, including the attitudes of psychiatrists, nursing staff, patients and their relatives, stigmatizing views regarding LAIs, issues related to patient autonomy, fear of side-effects, cost related issues etc. This symposium will deal with the following aspects in greater detail:1. The current evidence of LAIs in the management of Schizophrenia: Sandeep Grover2. The patient’s and caregivers’ perspectives about LAIs: Swapnajeet Sahoo3. The psychiatrists’ perspectives about LAIs: Aseem Mehra14/09/2021,Kurnool, A.PToDr Gowtam Saha PresidentIndian Psychiatry Society (IPS) drgautam@ancips2022.comThrough Proper ChannelSub: Proposal for a Symposium at ANCIPS, 2022Respected sir,Greeting on behalf of my Psychiatry friends & Colleagues. I am Dr M Shivashanker Reddy, currently working as Assistant Professor, Dept. of Psychiatry, Viswabharathi Medical College & Hospital, Kurnool. As world is recovering from pangs of COVID19, we are thrilled to know that there will be 73rd ANCIPS being planned in 2022 at Vishakhapatnam, A.P. On this prestigious, National conference, we like to propose a symposium on a burning issue: “Climate Change and its impact of Mental Health.” This is one of the important issue and talking point among the experts and social media. I am sure sir, this symposium will meet the expectations of organizers and participants.The topics under this symposium and speakers are listed as below:Topic 1: Climate Change: Disaster in the pipeline Dr Dinakaran D, MD, PDF,Assistant professor,Centre for Psychosocial Support in Disaster Management, NIMHANS, BangaloreTopic 2: Climate and its Bearing on Mental Health Dr Ravi kumar N, MD, (Ex-NIMHANS) Consultant Psychiatrist,VARMA Super-speciality Hospital,West Godavari (dt), A.PTopic 3: Does Climate Change increase the prevalence of Mental illness Dr Venkata Lakshmi Narasimha, MD, DM (Ex-NIMHANS)Assistant Professor, Department of Psychiatry, AIIMS, Deoghar, Jharkhand.Topic 4: Climate Change and its impact on Cognition & Cognitive disorders Dr Shivashanker Reddy M, MD, DM (Ex-NIMHANS)Assistant Professor, Department of Psychiatry,Viswabharathi Medical College and General Hospital, Kurnool (dt), A.PTopic 5: Mitigation strategies to decrease the impact of climate change on Mental HealthDr Jayakrishnan M, MD, DM (Ex-NIMHANS)Consultant Psychiatrist,IQRAA Hospital, Kozikhode, KeralaWarm Regards & RespectsDr Shivashanker Reddy 91-9739148894Shivakmc55@gmail.com/brianpsyclinic@gmail.com

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Mirror image study (10 years of follow-up and 10 of standard pre-treatment) of psychiatric hospitalizations of patients with severe schizophrenia treated in a community-based, case-managed programme

ObjectivesTo determine the psychiatric hospitalizations of patients with severe schizophrenia before (standard treatment in mental health centres) and during treatment in a comprehensive, community-based, case-managed programme, as well as the role played by antipsychotic medication (oral or long-acting injectable). MethodsObservational, mirror image study of ten years of follow-up and ten retrospectives (‘pre-treatment’: standard), of patients with severe schizophrenia in a community-based programme, with pharmacological and psychosocial integrated treatment and intensive case management (N = 344). Reasons for discharge from the programme and psychiatric hospital admissions (and whether they were involuntary) were recorded ten years before and during treatment, as well as the antipsychotic medication prescribed. ResultsThe retention achieved in the programme was high: after 10 years only 12.2% of the patients were voluntary discharges vs 84.3% on previous standard treatment. The number of patients with hospital admissions, and number of admissions due to relapses decreased drastically after entering the programme (P < .0001), as well the involuntary admissions (P < .001). Being on long-acting injectable antipsychotic medication was related with these results (P < .0001). ConclusionsTreatment of patients with severe schizophrenia in a comprehensive, community-based and case-managed programme achieved high retention rates, and was effective in drastically reducing psychiatric hospitalizations compared to the previous standard treatment in mental health units. Undergoing treatment with long-acting injectable antipsychotics was clearly linked to these outcomes.

Delphi panel on management, treatment goals and functional recovery with long-acting injectable antipsychotics in first episode and early phase schizophrenia

Delphi panel on management, treatment goals and functional recovery with long-acting injectable antipsychotics in first episode and early phase schizophrenia

Comparative effectiveness of long-acting injectable antipsychotics in a large naturalistic cohort across two European centers: Findings from the long-acting injectable antipsychotics collaborative (LAICO) study.

We aimed to evaluate and compare the use of the paliperidone palmitate-1 and 3-month (PP1M, PP3M), aripiprazole 1-month (A1M) and risperidone-LAI (RLAI) LAIs, using the following clinical outcomes: (1) the number of hospital admissions, (2) the number of hospital bed days, and (3) the use of concomitant treatments, including benzodiazepines, oral antipsychotics, and biperiden. For that purpose, we designed a cross-sectional study, from 2015 to 2021, based on non-institutionalized population accessing care from mental health services in Spain and UK who were prescribed with LAIs during 1 year. A total of 993 patients using a LAI were included. PP1M and PP3M LAIs were associated with a decreased risk of being prescribed benzodiazepines (OR ​= ​0.35, 95%CI ​= ​0.16–0.80, p ​= ​0.012; OR ​= ​0.16, 95%CI ​= ​0.07–0.38, p ​= ​0.001, respectively) and oral antipsychotics (OR ​= ​0.23, 95%CI ​= ​0.09–0.54, p ​= ​0.001; OR ​= ​0.28, 95%CI ​= ​0.11–0.67, p ​= ​0.005, respectively) compared with RLAI. A1M was also associated with a decreased risk (OR ​= ​0.29, 95%CI ​= ​0.12–0.69, p ​= ​0.005) of antipsychotic prescription compared with RLAI. Moreover, PP1M and PP3M groups were treated with lower diazepam equivalents doses compared to the A1M (p ​= ​0.021, p ​= ​0.026) and RLAI groups (p ​= ​0.036, p ​= ​0.039). Finally, PP3M was associated with lower hospital admissions and bed days compared with A1M (p ​= ​0.001; p ​= ​0.001) and RLAI (p ​= ​0.018; p ​= ​0.001). In conclusion, paliperidone LAIs had a more favourable impact on overall bed usage compared to A1M and RLAI. Furthermore, paliperidone LAIs and A1M lowered the use of concomitant psychiatric medication versus the biweekly LAIs while differences in combination and augmentation practices between cohorts are also highlighted. Our findings could be useful for clinicians and their practice.