‘A Stitch in Time – Managing Schizophrenia Effectively Long Term’

The treatment of chronic illnesses commonly includes the long-term use of pharmacotherapy. However, the full benefits of these medications are often not realised, because approximately fifty percent of patients do not take their medication as prescribed. 1 Barriers to medication adherence are complex and varied, and hence solutions to improve adherence must be multifactorial.1 As C Everett Koop, the famous American surgeon said: ‘Drugs don’t work in patients who don’t take them’. Various strategies to improve adherence have been studied, and one of these is to simplify medication regimens by reducing the complexity of the dosing regimen.

Of patients experiencing an acute psychotic episode, only 8 – 20% will recover.

In March 2021, Prof Christoph Correll gave a virtual presentation entitled ‘A Stitch in Time – Managing Schizophrenia Effectively Long Term’ to South African healthcare professionals. He set the scene with some sobering statistics. Of patients experiencing an acute psychotic episode, only 8 – 20% will recover. The remainder cycle through various stages of response, remission, relapse and resistance, which begs the question ‘people may be better, but are they well?’ One must also consider adverse effects when treating these patients, as adverse events are known to impact patient functioning and may also lead to treatment nonadherence.

Relapse prevention is crucial. Multiple relapses and exacerbation of symptoms result in long term residual symptoms and disability, increased risk of suicide attempts, decrease in treatment response, progressive decline in brain structure, greater use of healthcare resources, and an increased burden on family and caregivers. Avoid relapses and avoid the associated suffering.

Long acting injectables (LAIs) need to be considered earlier on in the treatment course

Long acting injectables (LAIs) need to be considered earlier on in the treatment course. A comprehensive meta-analysis of 137 studies by Kishimoto et al (2018) examined the effectiveness of LAIs vs oral antipsychotics in patients with schizophrenia.  LAIs were consistently superior regarding hospitalisation and all cause discontinuation rates. Another study by Tiihonen et al (2017) showed the rehospitalisation risk was 20-30% lower with LAIs vs equivalent oral formulations

In terms of tolerability, a study showed that the adverse effects experienced with a LAI vs the same oral antipsychotic did not differ significantly.  

In conclusion, it was shown that early integrated care has the best outcome for patients with schizophrenia. Relapse prevention is especially important in early phase patients who have the most to gain and the most to lose. LAIs improve outcomes in terms of antipsychotic discontinuation, relapse, hospitalisation and mortality risk and should be considered earlier and in more patients who are considered high risk for non compliance. LAIs offer a simple solution to increase adherence as they offer a once monthly dose, thereby eliminating the need to take tablets every day.

 

    References

     

    1. Brown MT and Bussel JK (2011) Mayo Clin Proc 96(4): 304 - 314
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