Depot and oral antipsychotics: patient preferences and attitudes are not the same thing

Abstract

Some clinicians believe that antipsychotic depot injections are unacceptable to patients. This cross-sectional study investigated patients' attitudes regarding antipsychotics, and included within-participant comparisons. Two hundred and twenty-two out-patients with schizophrenia/schizoaffective disorder completed the Drug Attitude Inventory (DAI-10), scales on insight, side effects and treatment preferences. Formulation preference was associated with current medication formulation: depots were preferred by 43% (33/76) on depot vs 6% (8/146) on orals (P < 0.001). Attitudes (DAI scores) regarding current formulation were influenced by illness duration, extrapyramidal symptoms and insight but not by formulation (depot vs oral). For those with experience of both formulations, participants currently on tablets scored depots less favourably than oral (4.27 vs 6.89, P < 0.001); those on depot did not differentiate. When voluntary patients on maintenance antipsychotics are asked about their attitudes to their current medication, those on depot respond similarly to those on oral. However, when asked to state a preference for formulation (depot vs oral), patients tend to favour their current formulation. Whatever leads some to switch from depot to oral, leaves a lasting negative impression of the depot and this may limit uptake of newer depots.

Social Interaction and Drug Attitude Effectiveness in Patients with Schizophrenia

“…Other studies have showed that the correlations between side effects and drug attitude tend to be weak [24,33]. This study showed that drug attitude was not affected significantly by side effects.…”

The Use of Long-Acting Injectable Antipsychotics in Schizophrenia

“…Similar findings were reported in a study of outpatients with schizophrenia or schizoaffective disorder in the United Kingdom. 124 Perceptions about LAI use may also differ among health care providers. In a survey in the United Kingdom, 125 most psychiatrists (91%) felt that LAIs were as efficacious as oral medications and improve patient adherence (81%) and prevent relapse (94%); however, despite this, 48% felt that depot medications are stigmatizing, and 69% believed LAI antipsychotics are less acceptable to patients.…”

“…Patients or families may view the physician's recommendation of LAI therapy as a form of punishment or as a sign that the patient is very ill or has recently worsened. 124 However, it should be recognized that there are many different types of nonadherence. Some patients exhibit what might be referred to as "distracted nonadherence," which results from issues such as cognitive impairment or disorganization.…”

The use of long-acting injectable antipsychotic medication

“…In cases where LAIs are offered, patient tend to show a more favourable attitude of LAIs which correlate with their knowledge of these formulations (Potkin et al 2013). This is supported by systematic review of 12 studies by Waddell and Taylor (2009) and several other studies (Heres et al 2007, Patel et al 2009, Waddell and Taylor 2009, Caroli et al 2011, Das et al 2014). …”