March 22, 2017
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BLOG: LAI antipsychotics as first-line treatment for schizophrenia

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Long-acting injectable antipsychotics are among the most effective treatments in psychiatry, yet they continue to be underutilized in patients with schizophrenia and are too often reserved only for those with the most severe symptoms or at a late stage of the disorder.

As a clinician, I see the case for long-acting injectable (LAI) antipsychotics to be used early in the disease continuum, when patients can achieve the most benefit from their impact.

Early intervention

Early intervention and consistent treatment play a critical role in the management of schizophrenia and can impact the potential long-term effects.

More studies are now suggesting LAI antipsychotics as a possible treatment strategy for early-phase or first-episode schizophrenia, during a stage in the disorder when intervention may lead to significant gains in outcome.

Research has shown that patients experience the greatest response to initial antipsychotic treatment in first-episode schizophrenia, with significant loss of response to a second antipsychotic and so on.

Choosing LAI antipsychotics early on may have considerable positive outcomes over the continuum of care.

Adherence to medication

Nonadherence to antipsychotic medication is a common issue among patients with schizophrenia. In fact, it has been estimated that 40% to 50% of patients with schizophrenia do not adhere to their medication regimens. The reasons vary — some feel better and don’t think they need to take the medication any longer, others reject the diagnosis completely — but the risks can be serious, including relapse and poorer outcomes overall.

If left untreated, patients with schizophrenia can show greater loss of cerebral gray matter, and damage to the brain increases with every psychotic episode. Early intervention with LAI antipsychotics may result in fewer relapses and fewer rehospitalizations — thus, less damage to the brain.

For a disorder that typically first appears in late adolescence or early adulthood, the need for effective and convenient treatment options that patients will adhere to on a continuous basis is even more important to achieve greater quality of life. This could mean the possibility of attending school, going to work, socializing and potentially maintaining more positive relationships with friends and family.

Education and awareness

Clinicians must employ all strategies at their disposal to enhance adherence and minimize risk of relapse.

Negative attitudes toward LAI antipsychotics among clinicians and patients has been a common issue, especially with early onset cases, and patients are often not fully informed about LAI antipsychotics by their psychiatric prescribing provider.

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In my experience, the benefits associated with LAI antipsychotic treatment options continue to be welcomed by most patients. Numerous prescription products are now offered in an injection form and perceived as mainstream. Ease of dosing once a month, or longer, relieves patients of the burden of remembering to take a pill. LAI antipsychotics can be administered once every month or every six weeks or once quarterly, and remain in the body for an extended period. Not offering LAIs in today’s healthcare climate ages a prescribing provider in many consumer’s minds.

More education is crucial to address the current stigma and misconceptions around LAI antipsychotics. As clinicians, it is our role to become educated on the treatment options that will yield the greatest outcomes for our patients and finding what makes sense for each individual case. Challenging our norms and old ways of thinking on behalf of patients should be a top priority to leverage interventions that can improve adherence and outcomes.

Disclosure: Kosicek reports serving as CEO of Alay Health Team and authoring Nurses, Jobs and Resumes: Resume Revisions for RNs From the New Grad RN to the Experienced RN and Nurses, Jobs and Money: A Guide to Advancing Your Nursing Career and Salary.

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Correll CU, et al. J Clin Psychiatry. 2016;77(suppl 3):1-24.

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Lacro JP, et al. J Clin Psychiatry. 2002;63(10):892-909.

Patel MX, et al. J Psychopharmacol. 2010;24(10):1473-1482.

Stahl SM. CNS Spectr. 2014;doi: 10.1017/S1092852913001016.

van Haren NE, et al. Neuropsychopharmacology. 2007;32(10): 2057-2066.