Comparison of treatment discontinuation and hospitalization among nonadherent patients initiating depot or oral typical antipsychotic medications

Novick, Diego; Haro, Josep María; Bertsch, Jordan; Anand, Hemant; Jemiai, N; Haddad, Peter M.

doi:10.1097/yic.0b013e328354db12

Cited by 13 publications

(17 citation statements)

References 28 publications

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“…In another similar study in Hungary, depot antipsychotics were found to have a lower hospitalization rate than many other oral antipsychotics [19]. Similar findings were observed in the Schizophrenia Outpatients Health Outcomes (SOHO) Study [35], a large pan-European, naturalistic, prospective, observational study of schizophrenia patients. That analysis of SOHO focused on non-adherent patients who were initiated on typical antipsychotics in oral or depot formulations ( n = 431) and found that patients initiated on depot formulations had a significantly lower rate of hospitalization and a lower mean number of hospitalizations following 6 months of treatment.…”

Section: Discussionsupporting

confidence: 59%

Predictors of psychiatric hospitalization during 6 months of maintenance treatment with olanzapine long-acting injection: post hoc analysis of a randomized, double-blind study

et al. 2013

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BackgroundHospitalization is a costly and distressing event associated with relapse during schizophrenia treatment. No information is available on the predictors of psychiatric hospitalization during maintenance treatment with olanzapine long-acting injection (olanzapine-LAI) or how the risk of hospitalization differs between olanzapine-LAI and oral olanzapine. This study aimed to identify the predictors of psychiatric hospitalization during maintenance treatment with olanzapine-LAI and assessed four parameters: hospitalization prevalence, incidence rate, duration, and the time to first hospitalization. Olanzapine-LAI was also compared with a sub-therapeutic dose of olanzapine-LAI and with oral olanzapine.MethodsThis was a post hoc exploratory analysis of data from a randomized, double-blind study comparing the safety and efficacy of olanzapine-LAI (pooled active depot groups: 405 mg/4 weeks, 300 mg/2 weeks, and 150 mg/2 weeks) with oral olanzapine and sub-therapeutic olanzapine-LAI (45 mg/4 weeks) during 6 months’ maintenance treatment of clinically stable schizophrenia outpatients (n=1064). The four psychiatric hospitalization parameters were analyzed for each treatment group. Within the olanzapine-LAI group, patients with and without hospitalization were compared on baseline characteristics. Logistic regression and Cox’s proportional hazards models were used to identify the best predictors of hospitalization. Comparisons between the treatment groups employed descriptive statistics, the Kaplan–Meier estimator and Cox’s proportional hazards models.ResultsPsychiatric hospitalization was best predicted by suicide threats in the 12 months before baseline and by prior hospitalization. Compared with sub-therapeutic olanzapine-LAI, olanzapine-LAI was associated with a significantly lower hospitalization rate (5.2% versus 11.1%, p < 0.01), a lower mean number of hospitalizations (0.1 versus 0.2, p = 0.01), a shorter mean duration of hospitalization (1.5 days versus 2.9 days, p < 0.01), and a similar median time to first hospitalization (35 versus 60 days, p = 0.48). Olanzapine-LAI did not differ significantly from oral olanzapine on the studied hospitalization parameters.ConclusionsIn clinically stable schizophrenia outpatients receiving olanzapine-LAI maintenance treatment, psychiatric hospitalization was best predicted by a history of suicide threats and prior psychiatric hospitalization. Olanzapine-LAI was associated with a significantly lower incidence of psychiatric hospitalization and shorter duration of hospitalization compared with sub-therapeutic olanzapine-LAI. Olanzapine-LAI did not differ significantly from oral olanzapine on hospitalization parameters.Trial registrationClinicalTrials.gov: NCT00088491

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Section: Discussionsupporting

confidence: 59%

Predictors of psychiatric hospitalization during 6 months of maintenance treatment with olanzapine long-acting injection: post hoc analysis of a randomized, double-blind study

et al. 2013

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“…In clinical practice the effectiveness of maintenance antipsychotic medication in reducing the risk of relapse in schizophrenia is often reduced by nonadherence [Novick et al 2012]. A Finnish observational study found that less than half of patients admitted to hospital for the first time with schizophrenia were continuing medication 30 days post discharge [Tiihonen et al 2011].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections

Das

Malik

Haddad

2014

Therapeutic Advances in Psychopharmacology

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Objectives: The objective of this study was to investigate attitudinal themes to antipsychotic long-acting injections (LAIs) in patients in an early intervention team (EIT). Methods: Interviews were carried out with outpatients purposively sampled from an EIT to represent patients currently prescribed antipsychotic LAIs, oral antipsychotics and those not prescribed antipsychotic medication. Interviews were conducted and analysed according to grounded theory. Recruitment stopped when saturation of themes was reached. Results: Interviews from 11 patients were analysed (median age 24 years). Attitudes to LAIs were condensed into three key categories: therapeutic alliance and the psychiatrists' recommendation of antipsychotic medication; patients' knowledge and beliefs about LAIs; and patients' views regarding the appropriateness of LAIs. Participants valued their psychiatrist's recommendation as to the most appropriate antipsychotic. Attitudes to LAIs varied but were most positive among those currently receiving a LAI. Among those not prescribed LAIs, some were open to considering a LAI if their clinician recommended it but others were opposed to such treatment and preferred tables. There was a lack of awareness of LAIs as a treatment option among those not prescribed a LAI. Delay in being offered a LAI was reported in the group currently prescribed a LAI. Several participants associated oral antipsychotics, LAIs and mental illness with stigma. Some not prescribed a LAI had misperceptions about the nature of this treatment. Participants regarded the advantages of LAIs as convenience and avoiding forgetting to take tablets, while disadvantages included injection pain, fear of needles and coercion. Conclusion: Lack of knowledge, misperceptions and stigma related to LAIs and other treatment options should be addressed by providing patients with accurate information. This will facilitate patients being involved in choices about treatment, and should they decide to accept medication, which drug and formulation is most appropriate for their needs. Clinicians should avoid making assumptions about patients' attitudes to LAIs; attitudes vary but some early intervention patients not prescribed LAIs are open to considering this treatment. Antipsychotic prescribing should result from a shared decision-making process in which clinicians and patients openly discuss the pros and cons of different formulations and drugs. The themes identified in this qualitative study require further exploration using quantitative methodology.

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“…Depot antipsychotics have been reported to be associated with better adherence to treatment as well as clinical outcomes than oral antipsychotics (Brnabic et al, 2011;Leucht et al, 2011a;Novick et al, 2012). However, it does not always sufficiently prevent relapse especially in the long run.…”

Section: Discussionmentioning

confidence: 99%

Ten year outcomes of outpatients with schizophrenia on conventional depot antipsychotics

Uchida

Suzuki

Sakurai

et al. 2013

International Clinical Psychopharmacology

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Long-term follow-up data of patients with schizophrenia on depot antipsychotics have been few and the longest follow-up period has been up to 7 years. We carried out a systematic chart review to examine 10-year outcomes for outpatients with schizophrenia who were receiving a conventional depot antipsychotic. Maintenance of outpatient status for 10 years was considered as a favorable outcome. From the initial sample of 1587 outpatients, 90 patients who were receiving a depot antipsychotic were included in this study (mean±SD, age 44.0±13.0 years; men, N=54). Haloperidol decanoate, fluphenazine decanoate, fluphenazine enanthate, and haloperidol decanoate plus fluphenazine enanthate were used in 53 (58.9%), 29 (32.2%), seven (7.8%), and one (1.1%) patients, respectively. These depot antipsychotics accounted for 36.9% of the total antipsychotic dosage on average. Seventeen patients (18.9%) successfully maintained outpatient status for 10 years. The most frequent reason for dropout was 'hospitalization' (N=49, 54.4%), followed by 'referral to another clinic/hospital' (N=9, 10.0%) and 'side effects' (N=7, 7.8%). As only 36.9% of the chlorpromazine equivalents were administered through depot antipsychotics, it is difficult to draw any firm conclusion. Still, the data suggest that even depot antipsychotics may not sufficiently prevent relapse in the treatment of schizophrenia.

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Comparison of treatment discontinuation and hospitalization among nonadherent patients initiating depot or oral typical antipsychotic medications

Cited by 13 publications

References 28 publications

Predictors of psychiatric hospitalization during 6 months of maintenance treatment with olanzapine long-acting injection: post hoc analysis of a randomized, double-blind study

Predictors of psychiatric hospitalization during 6 months of maintenance treatment with olanzapine long-acting injection: post hoc analysis of a randomized, double-blind study

A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections

Ten year outcomes of outpatients with schizophrenia on conventional depot antipsychotics

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