Chapter

Health professionals’ and patients’ attitudes to LAIs*

Maxine X Patel

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/9780199586042.003.0008
Health professionals’ and patients’ attitudes to LAIs*

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This chapter has considered the preferences, attitudes, and perspectives of clinicians and patients regarding antipsychotic LAIs. Various factors have been considered including medication coercion in addition to those previously reported in the literature. Clinical guidelines suggest that LAIs are indicated where there are concerns regarding medication adherence. In essence, staff and patient acceptance of LAI medication is variable, and the mode of delivery seems to be a major stumbling block. It is true that the evidence base for comparative effectiveness of antipsychotic LAIs (vs. oral) is not definitive (Adams et al. 2001). However, the LAI formulation also seems to have an ‘image’ problem, even though many patients already receiving LAI medication like it. This is especially true for FGA-LAIs. However, SGA-LAIs attempted to avoid this by rejecting the name of ‘depot’, which was perceived to be stigmatizing. The collective term LAIs, for both FGAs and SGAs in this formulation, is partly an attempt to move away from stigmatizing stereotypes (Patel et al. 2009d).

If LAIs are underutilized and variation in rate of use suggests this to be the case at least in some areas, then reasons for this might include patients’ concerns about coercion and erroneous assumptions by clinicians that they ‘know’ that patients will not accept an LAI. Psychiatrists are also likely to underestimate the numbers of patients who are non-adherent with oral medication. In turn, this adversely affects on offering patient choice especially if LAIs, that may offer enhanced relapse prevention, are not even discussed. Also as FGA-LAIs are used less frequently than previously, the working knowledge base is at risk of becoming diminished. The new clinical guidelines for schizophrenia in the United Kingdom (NICE 2009) states that clinicians should ‘consider offering depot/long-acting injectable antipsychotic medication to people with schizophrenia who would prefer such treatment after an acute episode’. Thus, clinicians need to have competence and confidence with providing patient choice for antipsychotic medication and this also includes LAIs.

In relation to prescribing, it is not the presence or absence of a needle that should determine the quality of the clinician-patient therapeutic alliance or the degree of patient autonomy. Rather it is how the clinician approaches patients and involves them in decision making, including antipsychotic LAI medication where appropriate.

Chapter.  9469 words.  Illustrated.

Subjects: Psychiatry

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