Among patients with early-phase schizophrenia, 91% were willing to try at least 1 dose of a long-acting injectable (LAI) antipsychotic medication, especially when the option was presented in a supportive manner by a clinician trained in discussing the treatment, according to a study published in the Journal of Clinical Psychiatry.

These results are from the recruitment phase of the PRELAPSE trial, which is aimed at evaluating the effectiveness of LAI antipsychotics on reducing hospitalization rates. The final study cohort included 234 patients, age 18 to 35 years with schizophrenia and less than 5 years of lifetime antipsychotic medication use, recruited from 19 mental health clinics in the United States between December 2014 and 2016. Investigators documented whether or not patients would be willing to accept treatment with an LAI antipsychotic medication (in this case, aripiprazole once monthly). The average age of the cohort was 25.2 [4.2] years, with predominantly male (75.3%) and African-American (43.6%) participants.

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Staff at the clinics were provided information on the role of nonadherence in relapse and rationale for LAI antipsychotic use, as well as training in shared decision making, communication strategies, and ways to discuss frequently asked questions about LAI antipsychotic medications. Role playing was used to identify ways to overcome potential barriers to the use of LAI antipsychotic medications across different healthcare settings.

At least 1 LAI antipsychotic injection was accepted by 213 of the patients (91.0%) during the first 3 months of the study. Of the 21 participants who did not receive an injection, only 4 refused; 2 were ineligible for an injection because they had not tolerated oral aripiprazole, 12 dropped out, and 3 had “other reasons.”

“Although PRELAPSE trial results are not yet available,” investigators stated, “we believe that a very strong case can currently be made for more frequent consideration and discussion of LAI antipsychotic use early in the course of schizophrenia treatment. We believe that even in early-phase patients, a much higher rate of LAI antipsychotic use can be achieved in community mental health centers than is currently the case in the United States.”

Reference

Kane JM, Schooler NR, Marcy P, Achtyes ED, Correll CU, Robinson DG. Patients with early-phase schizophrenia will accept treatment with sustained-release medication (long-acting injectable antipsychotics): results from the recruitment phase of the PRELAPSE trial. J Clin Psychiatry. 2019;80(3):18m12546.