Chapter

Long-acting injectable antipsychotics in early psychosis*

Robin Emsley, Bonga Chiliza, Laila Asmal and Mathias de Fleuriot

in Antipsychotic long-acting injections

Published on behalf of Oxford University Press

Published in print October 2010 | ISBN: 9780199586042
Published online February 2013 | e-ISBN: 9780191754708 | DOI: http://dx.doi.org/10.1093/med/9780199586042.003.0007
Long-acting injectable antipsychotics in early psychosis*

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Accumulating evidence suggests that early, effective intervention in schizophrenia is critical to achieving optimal long-term outcomes. However, although the initial response to treatment is often favourable, the long-term outcome is poor. Most patients experience frequent relapses or achieve only a partial response to treatment. Poor adherence to medication is a major factor here. Using an antipsychotic LAI to address poor adherence is an option that should be considered early in the illness, in keeping with modern public health principles of prevention of accruing morbidity. Several studies have evaluated LAIs in the early stages of illness. Results suggest good efficacy and tolerability. Clearly, long-term, prospective, blinded, randomized, controlled trials with larger samples comparing oral and LAI antipsychotic treatments in early psychosis patients are indicated. Such studies would more clearly determine the relative benefits and risks of antipsychotic LAIs in the early stages of the illness. Nevertheless, preliminary evidence suggests that, by assuring delivery of antipsychotic medication, the use of antipsychotic LAIs in the early phases of the illness could result in the majority of patients achieving sustained remission. If we were to achieve this, we would be providing these individuals with their best chance of an optimal outcome in terms of symptom remission, improved functionality and quality of life, and individual autonomy.

Given the need for early, effective intervention in schizophrenia (McGorry et al. 2005) together with the fact that that poor adherence is a major problem from the outset (Coldham et al. 2002), all possible methods of ensuring sustained adherence should be considered, including psychosocial interventions, optimizing treatment tolerability and efficacy, and considering the option of depot antipsychotics. The latter option requires a shift in our thinking, away from reserving antipsychotic LAIs for the chronic stages of the illness. This would also necessitate revision of current treatment guidelines.

Chapter.  7769 words.  Illustrated.

Subjects: Psychiatry

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