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Rethinking the role of long-acting atypical antipsychotics in the community setting

Altamura, Alfredo Carloa; Aguglia, Eugenioc; Bassi, Marianob; Bogetto, Filippod; Cappellari, Lodovicoe; De Giorgi, Serafinof; Fagiolini, Andreag; Ferrannini, Luigih; Girardi, Paoloi

International Clinical Psychopharmacology: November 2012 - Volume 27 - Issue 6 - p 336–349
doi: 10.1097/YIC.0b013e328357727a
Review

Schizophrenia is a relapsing and evolving condition, which requires treatment continuity. Increasing evidence shows that antipsychotic discontinuation is associated with relapse in most patients, and that early interventions have a positive impact on long-term outcomes. Poor adherence to antipsychotics is a major factor in the treatment of schizophrenia and a relevant risk factor for relapse. Considerable effort has been made toward improving adherence, including the development of long-acting injectable (LAI) antipsychotics. LAIs have traditionally been reserved for patients with repeated nonadherence; currently, several misconceptions prevent their more widespread use. The recent introduction of LAI formulations of atypical antipsychotics and the encouraging results in terms of the reduction in relapse rates and avoidance of hospitalization warrant a reassessment of the role of LAIs in the management of schizophrenia. This paper presents the position of a panel of nine Italian schizophrenia experts on the use of novel LAI medications, with a focus on community-based services, the prevailing setting of schizophrenia treatment in Italy. The need to change the attitude toward LAIs – no longer a treatment of last resort, but a component of multimodal strategies leading patients to remission and rehabilitation – is emphasized. The paper also presents recommendations for LAI atypical antipsychotic use in the community setting.

aDepartment of Mental Health, Psychiatry Clinic, University of Milan, ‘IRCCS Ospedale Maggiore Policlinico’ Foundation, Milan

bPsychiatry 2 Complex, ‘Niguarda Ca’ Granda’ Hospital, Milan

cPsychiatry Unit (UOPI), AOU ‘Policlinico Vittorio Emanuele’ University Hospital, Catania

dDepartment of Neurosciences, University of Turin, Turin

eDepartment of Mental Health, Camposampiero Hospital, Camposampiero

fDepartment of Mental Health, Lecce Hospital, Lecce

gDivision of Psychiatry, School of Medicine, University of Sienna, Sienna

hDepartment of Mental Health and Addiction, ASL 3 Genoa, Genoa

iPsychiatry Unit, ‘Sant’Andrea’ Hospital, Rome, Italy

Correspondence to Alfredo Carlo Altamura, MD, Department of Mental Health, Psychiatry Clinic, University of Milan, ‘IRCCS Ospedale Maggiore Policlinico’ Foundation, via F. Sforza 35, 20122 Milan, Italy Tel: +39 02 55035982; fax: +39 02 5458129; e-mail: carlo.altamura@unimi.it

Received December 20, 2011

Accepted June 26, 2012

© 2012 Lippincott Williams & Wilkins, Inc.