Psychiatrists’ attitude to antipsychotic depot treatment in patients with first-episode schizophrenia

Heres, Stephan; Reichhart, Tatjana; Hamann, Johannes; Mendel, Rosmarie; Leucht, Stefan; Kissling, Werner

doi:10.1016/j.eurpsy.2009.12.020

Cited by 62 publications

(84 citation statements)

References 35 publications

(41 reference statements)

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“…Rates of LAI use are particularly low in early intervention services [Heres et al 2011]. A significant proportion of clinicians, varying from 34% in a UK study [Patel et al 2010b] to 71% in a German study [Heres et al 2006], regard LAIs as inappropriate for patients with first-episode psychosis.…”

Section: Introductionmentioning

confidence: 97%

“…Clinicians' beliefs may act as a prescribing barrier to the use of LAIs in early schizophrenia and contribute to LAIs being reserved as a treatment of last resort for patients with chronic schizophrenia who have had repeated hospital admissions secondary to nonadherence with oral medication ('resolving door' patients). The belief that LAIs are inappropriate for patients with first-episode psychosis seems to partly stem from clinicians presuming that such patients are unlikely to accept a LAI [Heres et al 2011;Jaeger and Rossler, 2010]. Another reason may be that some treatment guidelines for schizophrenia emphasize relapse secondary to nonadherence with oral medication as the main indicator for LAI use (e.g.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 97%

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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“…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.…”

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confidence: 99%

Clinicians’ Attitudes Toward the Use of Long-Acting Injectable Antipsychotics

Samalin¹,

Charpeaud²,

Blanc³

et al. 2013

Journal of Nervous &Amp; Mental Disease

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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...

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“…There might be also a shift in the psychiatrists' view on the use of LAI in first-episode patients (50). A survey among 198 psychiatrists concluded that the principal objections were seen on the part of drugs (limited availability of the second-generation antipsychotics in depot form) or patients (first-episode patients frequently refuse LAI, patients underestimate risk of a relapse after first episode).…”

Section: Psychiatrists' Perception Of Lai Antipsychoticsmentioning

confidence: 99%