Clinicians Have Knowledge Gaps About Long-Acting Injectable Antipsychotic Agents

Despite current evidence that patients with schizophrenia may experience clinical benefits with long-acting injectable antipsychotic agents, clinicians underutilize these medications.

Significant gaps in knowledge have been observed among clinicians in the US regarding long-acting injectable antipsychotic agents (LAIs), according to study results presented at Psych Congress 2022 held from September 17 to 20, 2022, in New Orleans, Louisiana.

To better understand clinician use patterns and motivations, researchers distributed a survey about LAIs between March and July 2022 to US-based psychiatrists, psychiatric nurse practitioners (NPs), and psychiatric physician associates (PAs) who managed patients with schizophrenia. A total of 390 clinicians completed the survey.

Of the clinicians who completed the survey, 295 physicians and 85 NPs or PAs had community-based practices (82%), had been practicing for a mean of 20 years since training, treated 58 (standard deviation [SD], 105) patients with schizophrenia monthly, and managed 25% of their patients with LAIs.

Most respondents (72%) said they were satisfied with their LAI utilization, with only 1% saying their use was too high.

These results highlight a continuing need for education…to increase awareness of nonadherence and to instill confidence among clinicians who manage schizophrenia, including psychiatrists, psychiatric NPs, and psychiatric PAs.

A similar proportion of clinicians (72%) indicated their opinions about LAIs had evolved during their career, with 45% indicating their opinion was changed by reading peer-reviewed publications, 41% by an educational event, 30% by a colleague, 29% by their patient’s perception, 19% by a pharmaceutical representative, 14% by their training, 6% by their institutional treatment protocols, and 4% by national practice guidelines, respectively.

Most clinicians agreed with the statement that LAIs should be reserved for patients who did not adhere well to other medications (68%), and that most patients who are managed with oral antipsychotics will have adherence issues (60%).

When asked to estimate the proportion of patients who were not adherent to medication nationwide, the most common answer was that 41% to 60% did not adhere (37%). Conversely, when asked to estimate how many of their patients were nonadherent, most (54%) endorsed a low rate of nonadherence (£20%).

Generally, confidence regarding LAI utilization was low. Clinicians reported they were not at all or only moderately confident in their ability to manage LAI side effects (56%), to determine when a patient should be given an LAI (53%), to transition the patient from oral medications to LAIs (51%), or to know appropriate use and have further knowledge of approved LAIs (50%).

The major limitation of this study is the small sample size.

Study authors conclude, “Clinicians tend to underestimate the level of nonadherence among their patients compared with their estimate of nonadherence in the national population and many clinicians continue to reserve LAIs for patients with adherence issues. These results highlight a continuing need for education (eg, continuing medical education, peer-reviewed studies) to increase awareness of nonadherence and to instill confidence among clinicians who manage schizophrenia, including psychiatrists, psychiatric NPs, and psychiatric PAs.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Velligan D, Salinas GD, Belcher E, et al. Understanding the use of long-acting injectable antipsychotic agents in schizophrenia: a 2022 survey of US psychiatrists, nurse practitioners, and physician associates. Abstract presented at Psych Congress 2022; September 17-20, 2022. Poster 96.