Dr. Leslie Citrome: Clinical Professor of Psychiatry and Behavioral Sciences, New York Medical College
Dr. Jonathan Meyer: Voluntary Clinical Professor of Psychiatry, University of California, San Diego
Key Topics
1. Do LAIs Prevent or Delay Hospital Readmission?
Non-adherence Issue: Most people with chronic illnesses, including schizophrenia, are non-adherent with oral medications.
Effectiveness of LAIs:
Reduce risk of relapse substantially in patients with schizophrenia but not entirely.
Seen effective in both repeatedly hospitalized patients and first-episode patients.
Consequences of Non-adherence:
Irreversible effects on the brain which may affect antipsychotic response.
Early Intervention: Importance of using LAIs early after diagnosis to maximize benefits and minimize risks.
2. Do LAIs Work Better Than Oral Antipsychotics?
Adherence Assurance: LAIs mainly ensure adherence but do not inherently make the medication more effective.
Adherence Rates: About 50% of patients with schizophrenia are partially or non-adherent, similar rates seen in other chronic conditions like bipolar disorder, major depressive disorder, anxiety, diabetes, hypertension, and asthma.
Comparative Effectiveness: LAIs not necessarily more effective in symptom reduction if 100% adherence to oral medications.
3. Injection Frequency of LAIs
Range of Frequency: LAIs range from every two weeks to every six months.
Tailoring to Patient Needs:
Various options are available (e.g., subcutaneous risperidone with 1 or 2-month options).
Patient preference plays a significant role in determining frequency and type of injection (IM vs. subcutaneous).
Importance of knowing all options and how to use them effectively
Additional Insights
Shared Goals and Patient-Centric Approach:
Conversations around LAIs should focus on shared goals, addressing patient concerns and fears.
Continuous dialogue is crucial—ongoing discussions and reassessments.
Practical Approach: Sometimes convincing patients by suggesting a trial period with LAIs and reverting to pills if unsatisfactory.
Effective Psychiatric Tool: LAIs are considered one of the most effective tools in psychiatry, emphasizing the importance of learning how to use them and have productive conversations with patients.
Conclusion
Knowledge and Communication: Importance of understanding the variety of LAIs, their initiation, and loading regimens, and maintaining an open and ongoing dialogue with patients for optimal outcomes.