Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia
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BACKGROUND: The research goal is to better understand prescriber, patient, and caregiver perspectives about long-acting injectable (LAI) antipsychotic therapy and how these perspectives affect LAI use. Addressing these perspectives in the clinic may lead to greater success in achieving therapeutic goals for the patient with schizophrenia. METHODS: Ethnographic information was collected from a non-random sample of 69 prescriber-patient conversations (60 with community mental health center [CMHC] psychiatrists; 9 with nurse-practitioners) recorded during treatment visits from August 2011 to February 2012, transcribed and analyzed. Discussions were categorized according to 11 predetermined CMHC topics. In-person observations were also conducted at 4 CMHCs, including home visits by researchers (n = 15 patients) prior to the CMHC visit and observations of patients receiving injections and interacting with staff. Telephone in-depth interviews with psychiatrists, patients, and caregivers to gather additional information on LAI discussion, prescription, or use were conducted. RESULTS: Antipsychotic treatment decisions were made without patient or caregiver input in 40 of 60 (67%) of psychiatrist-patient conversations. Involvement of patients or caregivers in treatment decisions was greater when discussing LAI (15 of 60 [25%]) vs oral antipsychotic treatment (5 of 60 [8%]). LAIs were not discussed by psychiatrists in 11 of 22 (50%) patients taking oral antipsychotics. When offered, more LAI-naïve patients expressed neutral (9 of 19 [47%]) rather than favorable (3 of 19 [16%]) or unfavorable (7 of 19 [37%]) responses. Prescribers were most concerned about potentially damaging the therapeutic relationship and side-effects when discussing LAIs while patient resistance was often related to negative feelings about injections. Psychiatrists had some success in overcoming patient objections to LAIs by addressing and decomposing initial resistance. More than half (11 of 19 [58%]) of LAI-naïve patients agreed to start LAI treatment following office visits. Patient-described benefits of LAIs vs orals included perceived rapid symptom improvement and greater overall efficacy. CONCLUSIONS: In this study, many psychiatrists did not offer LAIs and most patients and caregivers were not involved in antipsychotic treatment decision making. Opportunities to increase active patient engagement, address resistances, guide patient drug-formulation selection, and provide better LAI-relevant information for more individualized approaches to treating the patient with schizophrenia were present.
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In Europe, only 40% of clinicians would use LAIs for treating first-episode psychosis, and a large portion tend to use LAIs only in patients with long-term disease and poor compliance.
“In Europe only 40% of clinicians would use LAIs for treating first-episode psychosis [32], while a large portion of them tend to use LAIs only in the case of patients with long-term disease and poor compliance [33, 34].”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [33]
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- Authors
- Potkin, S., Bera, R., Zubek, D., & Lau, G.
- Affiliations
- University of California, Irvine (US)
- Otsuka (United States) (US)
- Corresponding author
- Potkin, Steven
- ORCID
- Potkin, Steven
- Venue
- BMC Psychiatry
- Published
- 2013-10-16
- Volume
- 13
- Issue
- 1
- Pages
- 261-261
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3819472
- OpenAlex
- W2096003243
- Cited by
- 98
- References
- 33
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 19 · 2020: 12 · 2019: 11 · 2018: 4 · 2017: 7 · 2016: 3 · 2015: 6 · 2014: 4
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- Otsuka America
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- long-acting injectable antipsychotics, schizophrenia, caregiver involvement, community mental health centers, therapeutic relationship, patient preferences, oral antipsychotics, medication adherence, shared decision-making
- MeSH terms
- Adult, Attitude of Health Personnel, Attitude to Health, Delayed-Action Preparations, Female, Humans, Male, Middle Aged, Physician-Patient Relations, Psychiatry, Schizophrenia, Antipsychotic Agents
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