Use of Long-Acting Injectable Antipsychotic in an Inpatient Unit of a Community Teaching Hospital

Abstract

Background. Individuals with Schizophrenia Spectrum Disorders (SSD) often experience significant impairment in educational, occupational, and psychosocial functioning. The clinical benefit of long-acting injectable antipsychotics (LAIs) in the management of patients with SSD is well established. SSD patients who are nonadherent to treatment have lower disease relapse and readmission rates when prescribed a LAI, compared to oral antipsychotics. Despite the reported advantages of LAIs, their prescription rates in clinical settings remain low. This pilot study aimed to determine the pattern of LAI prescription in psychiatric inpatients of a teaching community hospital in Brooklyn, New York. Methods. A retrospective review of the charts of patients discharged from the psychiatric units of the hospital from September 1, 2017, through September 30, 2017, was conducted. Frequencies and proportions for demographic and disease-related characteristics were calculated. Pertinent continuous variables were recoded into categorical variables. Chi-square-tests or Fisher’s exact tests were performed for categorical variables. The one-sample Shapiro-Wilk test (for sample size < 50) was used to check for the normality of distribution of continuous variables. Statistical significance was defined as p ≤ 0.05. Results. Forty-three (70%) of the patients discharged from the inpatient unit during the study period had SSD and were eligible for a LAI. Their ages ranged from 20 to 71 years (mean = 41 years), and more than two-thirds were male. Less than half of the eligible patients (n = 19; 44%) were prescribed a LAI, most of whom were male (n=16; 84%). An association between age group (patients aged 41 years or younger) and LAI use was observed (p < 0.05), while gender, employment status, living arrangement, length of hospital stay, recent hospitalization, and cooccurring substance use disorder were not. Conclusion. LAI prescription rate at the inpatient psychiatric unit of the hospital was marginally higher than those reported in most studies. Age appears to influence LAI use during the study period. Initiatives that increase LAI prescription rate for all eligible patients admitted to inpatient psychiatric unit should be encouraged.

Use of Long-Acting Injectable Antipsychotics in Inpatients with Schizophrenia Spectrum Disorder in an Academic Psychiatric Hospital in Switzerland

“…The LAI prescribed most often was by far paliperidone palmitate followed by aripiprazole monohydrate while risperidone microspheres and first-generation LAI were prescribed in a small patient subgroup. These results are in contrast with the findings of Olayinka et al [19] who assessed LAI prescription rates in an inpatient setting and reported that 44% of a total of 43 patients with SSD were treated with an LAI. They found risperidone microspheres to be the most often used substance followed by paliperidone palmitate and haloperidol decanoate.…”

“…Similar trends were obtained by Kishimoto et al in an inpatient setting in New York City [18]. On the other hand, in a hospital mainly serving low-income and uninsured population in Brooklyn, New York City, authors reported that 44% of inpatients were treated with LAIs at time of discharge [19]. Beside these three studies there are to our knowledge no other data evaluating the use of LAI in acute psychiatric inpatient settings; additionally, none of these studies analyzed LAI prescription rates in Europe.…”

“…As a limitation one has to note that in those times most commonly first-generation antipsychotic LAIs were used and risperidone microspheres was the only available second-generation antipsychotic LAI. A potential reason underlying the differences regarding LAI prescription rates estimated in our sample and other studies such as for example the study of Olayinka et al in Brooklyn, New York, [19] maybe associated with differences in the socio-economic status of the patients included and the healthcare system. In fact, there is also a considerable difference for the duration of hospitalization (24.62 days average length of stay in our study vs. 14 days in the study by Olayinka et al [19]).…”

“…A potential reason underlying the differences regarding LAI prescription rates estimated in our sample and other studies such as for example the study of Olayinka et al in Brooklyn, New York, [19] maybe associated with differences in the socio-economic status of the patients included and the healthcare system. In fact, there is also a considerable difference for the duration of hospitalization (24.62 days average length of stay in our study vs. 14 days in the study by Olayinka et al [19]). In Switzerland the longer lengths of stay could be used for longer discussing the advantages and disadvantages of LAIs.…”

Attitudes and Willingness to Accept Long-Acting Injections for Patients With Schizophrenia in Beijing: A Cross-Sectional Investigation Based on Samples From the Communities

“…The disease has positive psychotic symptoms (hallucinations and delusions) and negative psychotic symptoms [lack of motivation, decreased feeling of pleasure, emotional retardation ( 1 ). Its typical characteristics are cognitive and emotional abnormalities, which cause significant damage to the patient's education, occupation, and psycho-social functions ( 2 ). The aim of treating schizophrenia is clinical, social and personal remission and prevention of relapses ( 3 ).…”