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Why are long-acting injectable antipsychotics still underused?

  • Peter Bosanac and David Jonathan Castle

Summary

‘Depot antipsychotics' (‘long-acting injectable antipsychotic medications' or LAIs) are underused in the treatment of schizophrenia (including first episodes) and, possibly, of schizophrenia with comorbid substance use disorders. Patients' and clinicians' beliefs and attitudes, and service barriers, affect best practice and evidence-based care in LAI prescription. Poor medication adherence is a key reason for LAI prescription, but patients receiving LAIs may still relapse or experience significant side-effects. Patients' and clinicians' attitudes towards antipsychotic medication, as well as the quality of their recovery-focused relationship, are key factors in adherence. Clinicians should avoid a dichotomous ‘oral v. LAI’ choice: LAIs may have a place at various stages in the continuum of care and they should be one of the options discussed with any patient requiring long-term treatment, even early in the illness course. Many clinicians need better education about LAIs and greater familiarity with schizophrenia treatment guidelines.

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Copyright

Corresponding author

Professor David Jonathan Castle, The University of Melbourne, Level 2–46 Nicholson Street, Fitzroy, Melbourne, Australia 3065. Email: david.castle@svha.org.au

Footnotes

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Learning Objectives

Understand the contemporary benefits and risks of LAIs in the continuum of care of schizophrenia Appreciate the barriers to the use of LAIs, including stigma and clinicians' attitudes Understand the role of a recovery-focused approach to optimising therapeutic utility of LAIs

Declaration of Interest

P.B. has received grant monies for research and travel support from Astra Zeneca. D.C. has received grant monies for research, and/or travel support and honoraria for talks and consultancy from Allergen, Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, Hospira, Janssen Cilag, Lundbeck, Organon, Pfizer, Roche, Sanof, Servier and Wyeth; he is a current Advisory Board Member for: bitopertin (Roche); Lu AA21004, asenapine and aripiprazole LAI (Lundbeck); desvenlafaxine and varenicline (Pfizer); quetiapine (Astra Zeneca).

Footnotes

References

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  • Peter Bosanac and David Jonathan Castle

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Why are long-acting injectable antipsychotics still underused?

  • Peter Bosanac and David Jonathan Castle
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