Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia

John M Kane, Christoph U Correll
Journal of Clinical Psychiatry 2019 September 17, 80 (5)
Acute and long-term objectives must be linked early in the treatment of schizophrenia. Maintenance therapy is pivotal in relapse prevention. Relapses are serious events that alter disease trajectory and are most often related to nonadherence. Patients with schizophrenia have a substantial risk of relapse, especially when they are nonadherent to antipsychotics. Because relapses are accompanied by structural brain changes, worsening symptoms, and increased treatment resistance when medication is resumed, clinicians must monitor nonadherence and offer strategies to avoid or improve it. Long-acting injectable (LAI) antipsychotics have the potential to reduce nonadherence, relapse, rehospitalization, and mortality, even among patients with first-episode schizophrenia and with comorbid substance use disorder. Long-acting formulations can be a very powerful strategy in helping to ensure that patients get the benefit of the medication they have been prescribed, as the use of LAIs is more easily monitored than oral medications due to the nature of their administration to patients. However, prescribers tend to believe that patients have negative attitudes about LAIs and avoid prescribing them. Patients should be offered the option of LAI antipsychotic treatment and should understand the logistics and the potential benefits of the regimen. LAIs differ regarding their initiation strategy, duration, and flexibility of injection intervals, in addition to the differences of the antipsychotic that the LAI formulation is based on. Presentation matters for LAI treatments to be accepted by patients and family members. Clinicians can use certain communication tools to improve their dialogue with patients about the benefits of switching from oral agents.

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