Long-acting injectable antipsychotics: Six-month follow-up of new outpatient treatments in Bologna Community Mental Health Centres

Abstract

Purpose This study aims to describe factors associated to treatment continuity and psychiatric relapses in patients treated with Long Acting Injectable antipsychotics (LAIs) in Bologna Community Mental Health Centers (CMHCs). Methods New LAI treatments administered between July 1, 2010 and June 30, 2015 in CMHCs were selected. The cohort was followed-up for 6 months; predictors of continuity and psychiatric admissions were investigated by using logistic regression- and Cox- analysis respectively. Results Among the cohort of 1 070 patients, only 222 (21%) continued LAI treatment during the follow-up. LAI continuity was higher with first generation agents (OR: 1.71, 95%CI 1.18–2.49) and in case of previous psychiatric hospitalizations (OR 2.00, 95%CI 1.47–2.74). Incidence of psychiatric hospital admissions showed a sharp reduction in the follow-up compared with 6-month period before initiation (from 458 to 212), and was associated with previous psychiatric hospitalizations (HR 3.20, 95%CI 2.22–4.59), immigration (HR 3.13, 95%CI 1.28–7.69) and LAI discontinuation (HR 1.14, 95%Cl 1.01–1.97). Conclusions Psychiatric hospital admission before LAI initiation was the main predictor both of LAI continuity and hospitalization during the follow-up.

Use of Long-Acting Injectable Antipsychotics in a Clinical Sample of Community-Dwelling Patients with Schizophrenia-Spectrum Disorders in Rural Greece

“…There were no differences between the two groups with regard to the rates of antipsychotic co-medication, nor with regard to co-administration of benzodiazepines or antidepressants. Unlike other recent reports from community mental health settings [ 28 , 51 ], in the present study, most patients on LAIs (17 out of 26, 65.4%) were in antipsychotic monotherapy. Supposedly, the practice of combining LAIs with oral medication corresponds to the complexity of cases, which may require additional drug treatment; the patients’ co-morbidities (e.g., depressive symptoms); and the different diagnoses that are included in the F20–F29 cluster of the ICD-10.…”

“…In a recent study of inpatients in Switzerland, it was found that only 28.1% of the patients treated with an antipsychotic that is available as an LAI formulation were prescribed an LAI, suggesting that only a portion of patients who may be eligible for LAI treatment actually receive it [ 30 ]. Moreover, in a study in Italy on community-dwelling patients with psychotic disorders who were prescribed an LAI, only 20.7% steadily continued that treatment over the six-month follow-up [ 28 ], which indicates the challenges in maintaining such treatment.…”

“…Another study in Italy, which looked at patients attending community mental health centers in the Province of Verona, found that the annual frequency of new treatments with LAIs was relatively stable over the five-year study period. On average, 5.4% of patients treated with antipsychotics were prescribed LAIs [ 28 ]. In Spain, the percentage of second-generation LAI prescriptions compared to total second-generation antipsychotic prescriptions increased from 9.8% to 16.4% over a six-year period (2011–2016) [ 29 ].…”

Predictors of long-acting injectable antipsychotic treatment discontinuation in outpatients with schizophrenia: relevance of the Drug Attitude Inventory-10

“…Previous studies outlined that illness-related factors such as severe psychopathology are commonly implicated in treatment discontinuation (Yang et al ., 2012; Brain et al ., 2013), and anamnestic data (e.g. recent psychiatric admissions before LAI treatment) influence the subsequent therapy continuity (Berardi et al ., 2019). Socio-demographic factors also play a role, as seen for family and social support (Rabinovitch et al ., 2009), and for employment (Verdoux et al , 2000; Brain et al ., 2013).…”

Views of patient relatives and health professionals about the reasons of the patients enrolled in the community mental health center to discontinue or irregularly continue the center

“…Instead of a hospital-centered care approach, community mental health practices, which are based on preventive and rehabilitation services, have multi-dimensional benefits for both the patient and family and society (Attepe Özden & İçağasıoğlu Çoban, 2018; Bilge et al, 2016; Şahin & Elboğa, 2019). In all the studies conducted worldwide, it has been seen that community mental health centers provide benefits to patients and families and thus the welfare of society (Berardi et al, 2019; Bratberg Jensen et al, 2019). Although there are studies in the literature investigating the effectiveness of community mental health centers and their contribution to the family and health professionals in treatment compliance (Attepe Özden & İçağasıoğlu Çoban, 2018; Compton, 2005; Donyağı, 2016; Ensari et al, 2013; Şahin & Elboğa, 2019; Söğütlü, 2014; Uz Gül et al, 2014; Yılmaz Karaman, 2018), fewer studies are investigating the reasons for irregularly continuing the center (Avcı et al, 2016; Bilge et al, 2016; Elstad & Hellzen, 2010).…”