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The use of long-acting injectable antipsychotics in an acute psychiatric unit

Published online by Cambridge University Press:  19 July 2023

G. Ortega-Hernández*
Affiliation:
1Hospital Vall d´Hebrón
N. Ramiro
Affiliation:
2Hospital San Rafael
F. Palma-Álvarez
Affiliation:
1Hospital Vall d´Hebrón
Ó. Soto-Angona
Affiliation:
1Hospital Vall d´Hebrón
M. F. Mantilla
Affiliation:
3Hermanas Hospitalarias-CSMIA Gracia, Barcelona, Spain
J. Duque
Affiliation:
2Hospital San Rafael
I. Gonzalo
Affiliation:
2Hospital San Rafael
F. Collazos
Affiliation:
2Hospital San Rafael
*
*Corresponding author.

Abstract

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Introduction

Long-acting injectable antipsychotic (LAI) are an important and arguably under-utilized therapeutic option, particularly where medication adherence is a priority (Pilon et al. Clin Ther 2017; 39 1972-1985).

In recent years, meta-analytic reviews of depot medications concluded that this route of administration produced clinical advantages in terms of overall outcome, with lower probability of relapse, readmissions, shorter hospital admission time, mortality, and thus better long- term prognosis over other oral antipsychotics (Leucht et al. Schizophr Res 2011;127 83-92). Depot treatment is associated with lower overall medical expenditure (Taipal et al. Schizophr Bull 2018;17 1381- 1387).

Objectives

To describe the evolution of people diagnosed with a psychotic disorder 6 months before and after the introduction of long-acting injectable antipsychotic (LAI) in the acute psychiatric unit of San Rafael Hospital (Spain) from January 1, 2018 to December 31, 2018.

Methods

Retrospective and prospective naturalistic study. Patients with a diagnosis of psychotic disorder who were admitted to the acute psychiatric unit in 2018 and who were introduced to LAI (paliperidone palmitate, aripiprazole, olanzapine pamoate or risperidone), are selected. Sociodemographic variables (sex, age, ethnicity, migratory status, marital status, occupation, cohabitation) and clinical variables (main and secondary diagnosis, comorbidity with drug use and history of poor adherence) are described. The number of emergency visits and hospital admissions before and after the introduction of LAI antipsychotic treatment is compared.

Results

The sample was composed of 99 subjects. The mean age was 42.46 years (SD 13.439) and 67.7% were men. The socio-demographic profile was: european caucasian ethnicity (73.7%), non- migrant status (69.7%), single (67.7%), inactive (43.4%) and residing in the home of relatives (50.5%). 53.5% have a diagnosis of schizophrenia, followed by schizoaffective disorder (24.2%). 45.5% are diagnosed with any drug use disorder, the most frequent being cannabis (30.3%). 76.8% have a history of discontinuing oral treatment. There was a statistically significant decrease (p<0.0001) in number of emergency visits and hospital admissions after the introduction of LAI antipsychotic.

In the general linear multivariate before-after model, there were significant differences (p=0.002) in the number of admissions after long-term IM antipsychotic treatment. As for the comparison of the effects between the different LAIs, there are differences between them (p< 0.0001). Post-hoc analysis (Bonferroni) only showed differential significance for treatment with Paliperidone Palmitate (p<0.0001).

Conclusions

The use of LAI antipsychotic can reduce the number of emergency room visits and hospital admissions, in line with literature.

Disclosure of Interest

None Declared

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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