Experts Encourage ‘Person-Centered’ Schizophrenia Care, LAI Usage at Inaugural PA Institute
At the inaugural Psych Congress PA Institute in Orlando, Florida, Co-Chair Kevin Williams, MS, MPAS, PA-C, and Craig Chepke, MD, DFAPA, Chief Medical Officer, Psych Congress, discussed issues of medication nonadherence, relapse prevention, and person-centered care in their session, “Essential Strategies for Optimizing the Use of Long-Acting Treatments in Schizophrenia.”
“We’re faced with an issue,” Williams said as he opened the presentation on Thursday afternoon. “58.2% of patients with schizophrenia and schizoaffective disorder discontinued their medication in the 6 months after discharge from an inpatient psychiatric unit.”
This statistic anchored the first section of the session, which was an exploration of the multilevel impact of medication non-adherence and discontinuation in schizophrenia. Patients who have discontinued treatment may face individual consequences, like risk of brain tissue loss, substance use relapse, and treatment resistance, which are compounded by social and economic stressors, including unemployment and increased relational strain.
These issues culminate in public health burden, increasing healthcare utilization costs and rates of arrest and incarceration.
To address these concerns, the presenters encouraged the use of long-acting injectable (LAI) antipsychotics, diving into data that explore potential advantages of LAI options over oral agents.
Williams first cited the pharmacokinetic differences in oral and LAI agents, noting that plasma concentrations are more stable in LAIs than oral options. Less erratic plasma levels leave less opportunity for relapse events, he explained.
Dr Chepke then provided an overview of recent data on Food and Drug Administration (FDA)-approved LAI options, including aripiprazole lauroxil, risperidone polymer subcutaneous 1-2 month, and paliperidone palmitate 6-month (PP6M). While data show that LAIs may have certain benefits over oral options, he noted that LAIs with a duration longer than 1 month may confer an even greater benefit than shorter-term LAIs, further bolstering the argument for their use in clinical practice.
Despite these benefits, as well as the decrease in pill burden afforded by an LAI, the presenters acknowledged that the adoption of LAIs is inhibited by several factors, including lack of training on how to administer the injections, misconceptions that LAIs are only for nonadherent patients, and pervasive stigma.
“We have stigmatized LAIs in a way no other field does,” said Dr Chepke, who likened the treatment option to commonly prescribed injections like adalimumab (Humira) and semaglutide (Ozempic) for other ailments.
To overcome these barriers and potential patient concerns, the clinicians highlighted the importance of shared decision-making and effective communication strategies. For example, when introducing a LAI option to a patient, Dr Chepke recommended leading with the benefits of the formulation, rather than the route of administration.
The clinicians also implored audience members to consider the importance of adopting an individualized, person-centered approach. By leveraging motivational interviewing strategies, clinicians may be better able to understand the needs, fears and treatment goals of their patients.
For clinicians who may not be comfortable utilizing LAIs in their practice, the presenters encouraged the attendance of professional conferences that offer hands-on training opportunities and continued education on LAI administration and prescription to better familiarize themselves with a treatment option that, Williams and Dr Chepke believe, should be available to all patients with schizophrenia.
“We need to do a better job as a community to offer [LAIs],” Dr Chepke urged.
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