Volume 5 Issue 9 September, 2015
Consultation Liaison Psychiatry Focus: ‘Psychopharmacology’
Schizophrenia affects approximately 1% of the population in their lifetime, and is a chronic devastating illness with major impact on social and occupational functioning and activities of daily living. Therefore, maintenance treatment with antipsychotics is a core feature of its long-term management. The unpleasant adverse effects of antipsychotic drugs combined with patients’ disbelief of having an illness, which is common among individuals with schizophrenia, result in high rates of non-adherence to antipsychotics. Such non-adherence is in turn is one of the most important risk factors for relapse and hospitalization in patients receiving treatment for schizophrenia. Hence, improving medication adherence is critical to improving outcomes in patients with schizophrenia.
Long-acting depot antipsychotics were developed specifically to promote treatment adherence (compliance) and they are a valuable option for patients requiring maintenance medication for schizophrenia. Various antipsychotics available as depot preparations include fluphenazine, haloperidol, paliperidone and risperidone. The long acting injectable (LAI) preparations facilitate the lowest effective dose administration due to avoidance of hepatic first pass metabolism. Also there is consistent bioavailability and a more predictable correlation between dosage and plasma levels with these preparations. Other advantages include ensured administration and transparency of adherence, less probability for rebound symptoms and relapses, reduced risk of unintentional or deliberate overdoses, no need for daily administration, improved patients outcomes, and improved patient and physician satisfaction. However, these preparations are not devoid of disadvantages which include longer time to achieve steady state levels, slow dose titration, less flexibility of dose adjustment, pain at the injection site, and irritation and lesions due to leakage into subcutaneous tissue especially with oily injectables. Data regarding differences between LAI of typical and atypical antipsychotics are much sparse. Few studies reported that switching from haloperidol to risperidone LAI was associated with significant improvement in cognitive function including memory, executive function, motor processing function, and attention disorder symptoms; better patient satisfaction, and improved sleep and health quality; which was however at the cost of more weight gain and hyperprolactinemia.
LAIs should be considered a useful and possibly effective treatment that patients may consider choosing as an option to help them in their recovery. Indeed, LAIs may be a positive choice to enable patients to manage their psychosis and achieve their personal goals. Although some LAIs are expensive, they potentially reduce the financial burden of schizophrenia and improve quality of life.
Dr Rakesh Mittal, Assistant Professor, Dr Niti Mittal, Senior Resident Department of Pharmacology, PGIMS, Rohtak, Haryana
