Risperidone Long‐acting Injection (RLAI) – real world outcomes from the United Kingdom high‐secure hospitals

Abstract

Purpose -High-secure hospital patients often have complex presentations that are marked by co-morbidity, violence, histories of poor concordance with oral medication, and treatment resistance. The ability to give a long-acting medication with a low propensity for extra pyramidal side effects is of potential value to clinicians treating these patients. Risperidone Long-acting Injection (RLAI) is the first long-acting atypical antipsychotic medication and may be potentially useful in this population. This paper aims to investigate this issue.Design/methodology/approach -This was a retrospective, naturalistic study to investigate the use and effectiveness, using hard outcome measures, of RLAI in the four UK high-secure psychiatric hospitals. Hospital pharmacy databases at Ashworth, Broadmoor, Carstairs and Rampton hospitals were used to identify all patients who had been prescribed RLAI. Anonymised data were then obtained from the pharmacy databases and case notes which were then pooled.Findings -A total of 159 patients were prescribed RLAI, most of whom had schizophrenia. The mean length of treatment with RLAI was 65 weeks (range two to 260 weeks) and the mean maximum dose was 43.2 mg every two weeks (range 25-75 mg every two weeks). No serious adverse effects were reported. In total, 42 per cent (67) patients responded to RLAI in as much as that they either remained on it in the long-term or were discharged to conditions of lower security whilst taking it. As there was no control group, it is not possible to determine if RLAI was a significant factor in such discharges to conditions of lower security. Of those patients who failed to respond to RLAI, 44 per cent were subsequently treated with clozapine.Originality/value -This pragmatic multi-centre study of a small but complex patient group demonstrated that RLAI was effective in 42 per cent of patients and was well-tolerated.

Psychotropic prescribing in seriously violent men with schizophrenia or personality disorder in a UK high security hospital

“…Prescribing of LAI antipsychotics in our population was higher than in other psychiatric settings as reported in the literature, with 36.5% being on a LAI antipsychotic compared with approximately 30% across other settings 19 20 There are previous studies from HSHs reporting the benefit of the use of LAI antipsychotic medication 21 22 Although it has not been explored in the literature, it can be hypothesized that LAI antipsychotics may be beneficial to violent schizophrenia patients such as ours because of the reduction in noncompliance it offers.…”

“…19,20 There are previous studies from HSHs reporting the benefit of the use of LAI antipsychotic medication. 21,22 Although it has not been explored in the literature, it can be hypothesized that LAI antipsychotics may be beneficial to violent schizophrenia patients such as ours because of the reduction in noncompliance it offers.…”

Long-acting injectable antipsychotics for prevention and management of violent behaviour in psychotic patients

“…The clinical impact of risperidone LAI (R‐LAI) was examined retrospectively in a sample of 159 patients with schizophrenia or schizoaffective disorder (84% males, mean age 37.9 years) from three UK high‐security hospitals . Clinical response indexed either as a discharge from high‐secure care or as a continuous administration of R‐LAI, was observed in 36% patients.…”

Effectiveness of paliperidone depot injection in seriously violent men with comorbid schizophrenia and dissocial personality disorder in a UK high-security hospital

“…High-security hospital patients often have complex presentations that are marked by comorbidity, violence, poor concordance with oral medication and treatment resistance [Gibbon et al 2011]. Although RIS-LAI and olanzapine pamoate have been demonstrated as showing a clinical benefit in these patients [Gibbon et al 2011; Baruch et al 2014], there is a scarcity of literature about the role of depot antipsychotic medication in this subgroup and there is no previously published work evaluating the effects of PP.…”