Long-Acting Injectable Better for First-Episode Schizophrenia?

New research finds that schizophrenic patients who took a long-acting injectable (LAI) form of risperidone had a much lower risk of symptoms returning than those who took the daily medication as a pill, and the study authors say that physicians may want to consider prescribing an LAI form of risperidone earlier in the course of treatment.

In a study following 83 individuals recently diagnosed with schizophrenia for 1 year, half of the patients were given the daily oral form of risperidone, with the other half being administered the long-acting injectable form. According to the authors, all interventions were given as part of the UCLA Aftercare Research Program.
______________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
New Study Provides Insight into Causes of Schizophrenia
OCD Linked to Higher Risk of Schizophrenia
______________________________________________________________________________________________________________________________________________________________________

The investigators found that patients taking the injectable form of risperidone were much more likely to adhere to treatment than those taking the oral form. In addition, the researchers discovered that the injectable performed better in terms of controlling symptoms. Over the 1-year follow-up period, 5% of those given the LAI form saw psychotic symptoms come back, while 33% of those taking the pill experienced the same reoccurrence of symptoms.

The findings indicate that “long-acting injectable antipsychotic medications should become a first-line treatment soon after the initial episode of schizophrenia,” says Kenneth Subotnik, PhD, an adjunct professor of psychiatry at UCLA’s Semel Institute for Neuroscience and Human Behavior, and first author of the study.

The overarching message to be taken from the research “is that long-acting antipsychotic medication is readily accepted by schizophrenia patients soon after the onset of the disorder, and is excellent for preventing psychotic symptom return and psychiatric hospitalization,” says Subotnik.

Providing long-acting injectable medication at the primary care physician’s office might be an ideal solution to the common obstacles to providing injectable medication at a psychiatrist’s office, he continues, adding that “most offices of private practice psychiatrists are not set up to provide injections, because they do not have a nurse or other staff member who can provide the injections.”

Some long-acting injectable medications also require a refrigerator for temperature control, says Subotnik, noting that the gluteal injections required by some long-acting antipsychotics raise concerns about whether another staff member should be present for the injection. 

“An additional consideration is that private practice psychiatrists might not always be able to bill for administering the injections, but a primary care practitioner office is not likely to have this issue,” he says, adding that “the psychiatrist should still be involved in the selection of the long-acting injectable medication and monitoring both its effectiveness and possible side effects.

“Schizophrenia patients are often unable to appreciate the seriousness of non-psychiatric medical problems and do not seek regular medical care,” concludes Subotnik. “Thus, another advantage of administering long-acting injectable medication at a private care practitioner’s office is that other medical issues are more likely to be identified and treated.”

—Mark McGraw

Reference

Subotnik K, Casaus L, et al. Long-Acting Injectable Risperidone for Relapse Prevention and Control of Breakthrough Symptoms After a Recent First Episode of Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry. 2015.