1151 – Clinicians’ attitudes toward the use of long-acting injectable antipsychotics

Abstract

Depot formulations are not widely used in everyday practice. This study aimed to assess psychiatrists' attitudes toward the use of long-acting injectable (LAI) antipsychotics in schizophrenia. We interviewed 113 French psychiatrists about the factors that influenced their prescription of LAI antipsychotics. Multidimensional and cluster analyses were used to detect correlations. The most important factor against the use of LAI antipsychotics is a sufficient estimated compliance with the oral formulation. For first-generation LAI, the main factor is the risk for extrapyramidal symptoms; and for secondgeneration LAI, it is the unavailability of the equivalent oral formulation. Four factors incite the psychiatrists to prescribe LAI. Two different clusters of patients can also be identified. Most factors influencing the clinicians' attitudes toward the use of LAI antipsychotics are shared in many countries. Conversely, some attitudes related to organizational aspects, particularly the relevance of health care costs, may vary from one country to another.Key Words: Antipsychotics, long-acting injectable, attitudes, schizophrenia (J Nerv Ment Dis 2013;201: 553Y559) A ccording to systematic reviews, between 40% and 60% of patients with schizophrenia are known to be partially or totally noncompliant to oral antipsychotic medication (Dolder et al., 2002;Valenstein et al., 2004). Poor adherence is associated with higher risk for relapse of schizophrenia and increased health care costs (Patel et al., 2008).However, depot formulations are not widely used in routine practice, with a prescription rate of generally lower than 30% in different countries (Barnes et al., 2009; Patel and David, 2011). However, the use of long-acting injectable (LAI) formulations varies between countries. The prescription rates are higher in France (23.5%;Fourrier et al., 2000) and in the United Kingdom (29%; Barnes et al., 2009) compared with other European countries and with Canada (6.3%; Williams et al., 2006) or the United States (17.6%; West et al., 2008).This discrepancy between countries can be considered to derive from the health care system and from the different attitudes displayed by psychiatrists.Perceived coercion or presumed risks for lower tolerance of depot forms have been identified as factors responsible for this low use (Heres et al., 2006; Patel and David, 2011). More generally, negative attitudes from practitioners toward these forms have been shown to account for part of the low prescription rates of depot antipsychotics (Hamann et al., 2010;Heres et al., 2006Heres et al., , 2008Heres et al., , 2011.The main goal of our study was to assess the attitudes of psychiatrists toward LAI antipsychotics in patients with schizophrenia to understand the reasons for using or not assigning depot treatment.We studied these attitudes in a sample of psychiatrists working in France using the same questionnaire that was used in a population of German psychiatrists (Heres et al., 2006(Heres et al., , 2008. Our results will be discus...