Journal List > Korean J Schizophr Res > v.16(1) > 1057786

Lee, Lee, Youn, Choi, Kim, and Chung: The Preference Survey for Long-Acting Injectable Antipsychotics of Community-Dwelling Patients with Schizophrenia and their Caregivers

Abstract

Objective

The prescription rates of long-acting injectable (LAI) antipsychotics are very low around 1% in Korea. This study was aimed to explore the preference of LAIs in patients with schizophrenia, who are currently living in community, and their caregivers.

Methods

The patients, diagnosed with schizophrenia by DSM-IV TR and were registered in the 31 mental health centers of Gyeonggi province and their caregivers were inquired the knowledge of the LAIs. The questionnaires contained information such as demographic characteristics, history of psychiatric treatment, and so on.

Results

About 5,318 were registered in 31 community mental health centers of Gyeonggi province in February 2012. The questionnaires of 614 patients and 365 caregivers were gathered from 20 community mental health centers. The mean ages (±SD) of patients and caregivers were 41.9 (±10.2) and 62.2 (±13.4) years old, respectively. 272 patients (44.6%) had experienced the discontinuation of medications without doctor's consent. 217 patients (35.9%) and 97 caregivers (27.1%) knew about the LAIs. The preference rates for LAIs were 35.2% and 46.8% for the patients and caregivers, respectively.

Conclusion

There is still huge discrepancy between the preference and the real prescriptions of LAIs in community-dwelling patients and their caregivers, much higher than in those of hospital settings. This study suggests that both patients and caregivers registered in the community mental health centers have a strong commitment to live in the community. The obstacles against the benefits of LAIs need to be resolved.

REFERENCES

1). Hong JP, Hwang SC, Lee YM, Lee SH, Shin NL, Lee JI, et al. Community Psychiatry Training for Psychiatry Residents. J Korean Neuropsychiatr Assoc. 2008; 47:88–93.
2). Harvey CA, Jeffreys SE, McNaught AS, Blizard RA, King MB. The Camden Schizophrenia Surveys III: five-year outcome of a sample of individuals from a prevalence survey and the importance of social relationships. Int J Soc Psychiatry. 2007; 53:340–356.
3). WHO-AIMS report on mental health system in republic of Korea. WHO, Ministry of Health & Welfare, Republic of Korea. 2007.
4). National report for the protection and improvement of the rights of person with mental illness. National Human Rights Commission of Korea. 2009.
5). Lee MS, Hong JP, Ko JA, Oh JH. Follow-Up Survey of Discharged Patients by the Mental Health Review Board. J Korean Neuropsychiatr Assoc. 2009; 48:42–47.
6). Schennach R, Obermeier M, Meyer S, Jäger M, Schmauss M, Laux G, et al. Predictors of relapse in the year after hospital discharge among patients with schizophrenia. Psychiatr Serv. 2012; 63:87–90.
crossref
7). Osborne RH, Dalton A, Hertel J, Schrover R, Smith DK. Health-related quality of life advantage of long-acting injectable antipsychotic treatment for schizophrenia: a time trade-off study. Health Qual Life Outcomes. 2012; 10:35.
crossref
8). Keith SJ, Kane JM, Turner M, Conley RR, Nasrallah HA. Academic highlights: guidelines for the use of long-acting injectable atypical antipsychotics. J Clin Psychiatry. 2004; 65:120–131.
9). McCabe R, Bullenkamp J, Hansson L, Lauber C, Martinez-Leal R, Rössler W, et al. The therapeutic relationship and adherence to antipsychotic medication in schizophrenia. PLoS One. 2012; 7:e36080.
crossref
10). Hough D, Gopal S, Vijapurkar U, Lim P, Morozova M, Eerdekens M. Paliperidone palmitate maintenance treatment in delaying the time-to-relapse in patients with schizophrenia: a randomized, double-blind, placebo-controlled study. Schizophr Res. 2010; 116:107–117.
crossref
11). Lambert T, de Castella A, Kulkarni J, Ong A, Singh B. One year estimate of depot antipsychotic adherence and readmission in Australian community mental health settings. Schizophr Bull. 2007; 33:485.
12). Leucht C, Heres S, Kane JM, Kissling W, Davis JM, Leucht S. Oral versus depot antipsychotic drugs for schizophrenia-a critical systematic review and metaanalysis of randomised longterm trials. Schizophr Res. 2011; 127:83–92.
crossref
13). Viala A, Cornic F, Vacheron MN. Treatment adherence with early prescription of long-acting injectable antipsychotics in recent-onset schizophrenia. Schizophr Res Treatment. 2012; 2012:368687.
crossref
14). Lambert T, Olivares JM, Peuskens J, Desouza C, Kozma CM, Otten P, et al. Effectiveness of injectable risperidone long-acting therapy for schizophrenia: data from the US, Spain, Australia, and Belgium. Ann Gen Psychiatry. 2011; 10:10.
crossref
15). Spill B, Konoppa S, Kissling W, Maino K, Messer T, Heres S. Longterm observation of patients successfully switched to risperidone long-acting injectable: A retrospective, naturalistic 18-month mirror-image study of hospitalization rates and therapy costs. Int J Psychiatry Clin Pract. 2010; 14:53–62.
crossref
16). Ascher-Svanum H, Zhu B, Faries DE, Salkever D, Slade EP, Peng X, et al. The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC psychiatry. 2010; 10:2.
crossref
17). Kim B, Lee SH, Choi TK, Suh S, Kim YW, Lee E, et al. Effectiveness of risperidone long-acting injection in firstepisode schizophrenia: in naturalistic setting. Prog Neuropsychopharmacol Biol Psychiatry. 2008; 32:1231–1235.
crossref
18). Kim SW, Yoon JS. A Survey on Attitudes of Korean Psychiatrists Toward Long-Acting Injectable Antipsychotics: An Interim Analysis. Korean J Psychopharmacol. 2011; 22:S10–S17.
19). Wheeler A, Vanderpyl J, Carswell C, Stojkovic M, Robinson E. One-year treatment continuation in patients prescribed risperidone long-acting injection in New Zealand: a retrospective study. Clin Schizophr Relat Psychoses. 2012; 6:61–68.
crossref
20). Barnes TR, Shingleton-Smith A, Paton C. Antipsychotic long-acting injections: prescribing practice in the UK. Br J Psychiatry Suppl. 2009; 52:S37–S42.
crossref
21). Kang G, Kang S, Yoon H, Lee J. Attitudes of patients with schizophrenia and their caretakers toward treatment with long-acting injectable antipsychotic medication. J Korean Assoc Soc Psychiatry. 2010; 15:67–73.
22). Sunwoo YK, Kim JY, Bae JN, Kim CE. A female patient with schizophrenia treated with risperdal consta during the entire period of pregnancy. Korean J Psychopharmacol. 2006; 17:573–575.
23). Youn T. A Case of Aggressive and Violent Patient with Treatment-Resistant Schizophrenia Treated with Long-Acting Injectable Risperidone. Korean J Psychopharmacol. 2007; 18:171–176.
24). Park H, Bae S, Ryoo J, Kim S, Lim W. Attitudes of Korean psychiatrists toward treatment long-acting injectable antipsychotic. J Korean Neuropsychiatr Assoc. 2009; 48:182–189.
25). Kane JM, Leucht S, Carpenter D, Docherty JP. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003; 64:5–19.
26). Nasrallah HA, Gopal S, Gassmann-Mayer C, Quiroz JA, Lim P, Eerdekens M, et al. A controlled, evidence-based trial of paliperidone palmitate, a long-acting injectable antipsychotic, in schizophrenia. Neuropsychopharmacology. 2010; 35:2072–2082.
crossref
27). West JC, Marcus SC, Wilk J, Countis LM, Regier DA, Olfson M. Use of depot antipsychotic medications for medication nonadherence in schizophrenia. Schizophr Bull. 2008; 34:995–1001.
crossref
28). 2012년 상반기 약제급여적정성평가 추구관리 결과. 건강보험 심 사 평가원 급여평가실 평가2부;2012.
29). Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, et al. Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. Am J Psychiatry. 2004; 161:692–699.
crossref
30). Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002; 63:892–909.
31). Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005; 353:1209–1223.
crossref
32). Fenton WS, Blyler CR, Heinssen RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia bulletin. 1997; 23:637–651.
crossref
33). Nasrallah HA, Duchesne I, Mehnert A, Janagap C, Eerdekens M. Health-related quality of life in patients with schizophrenia during treatment with long-acting, injectable risperidone. J Clin Psychiatry. 2004; 65:531–536.
crossref
34). Nasrallah HA. The case for long-acting antipsychotic agents in the post-CATIE era. Acta Psychiatr Scand. 2007; 115:260–267.
crossref
35). Marinis TD, Saleem PT, Glue P, Arnoldussen WJ, Teijeiro R, Lex A, et al. Switching to long-acting injectable risperidone is beneficial with regard to clinical outcomes, regardless of previous conventional medication in patients with schizophrenia. Pharmacopsy-chiatry. 2007; 40:257–263.
crossref
36). Gopal S, Hough DW, Xu H, Lull JM, Gassmann-Mayer C, Remmerie BM, et al. Efficacy and safety of paliperidone palmitate in adult patients with acutely symptomatic schizophrenia: a randomized, double-blind, placebo-controlled, dose-response study. Int Clin Psychopharmacol. 2010; 25:247–256.
crossref
37). Hough D, Lindenmayer JP, Gopal S, Melkote R, Lim P, Herben V, et al. Safety and tolerability of deltoid and gluteal injections of paliperidone palmitate in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2009; 33:1022–1031.
crossref
38). Kramer M, Litman R, Hough D, Lane R, Lim P, Liu Y, et al. Paliperidone palmitate, a potential long-acting treatment for patients with schizophrenia. Results of a randomized, double-blind, placebo-controlled efficacy and safety study. Int J Neuropsychopharmacol. 2010; 13:635–647.
crossref
39). Pandina GJ, Lindenmayer JP, Lull J, Lim P, Gopal S, Herben V, et al. A randomized, placebo-controlled study to assess the efficacy and safety of 3 doses of paliperidone palmitate in adults with acutely exacerbated schizophrenia. J Clin Psychopharmacol. 2010; 30:235–244.
crossref
40). Gopal S, Pandina G, Lane R, Nuamah I, Remmerie B, Coppola D, et al. A Post-hoc Comparison of Paliperidone Palmitate to Oral Risperidone During Initiation of Long-acting Risperidone Injection in Patients with Acute Schizophrenia. Innov Clin Neurosci. 2011; 8:26–33.
41). Pandina G, Lane R, Gopal S, Gassmann-Mayer C, Hough D, Remmerie B, et al. A double-blind study of paliperidone palmitate and risperidone long-acting injectable in adults with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35:218–226.
crossref
42). Li H, Rui Q, Ning X, Xu H, Gu N. A comparative study of paliperidone palmitate and risperidone long-acting injectable therapy in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35:1002–1008.
crossref
43). Llorca PM, Miadi-Fargier H, Lancon C, Jasso Mosqueda G, Casa-debaig F, Philippe A, et al. Cost-effectiveness analysis of schizophrenic patient care settings: impact of an atypical antipsychotic under long-acting injection formulation. Encephale. 2005; 31:235–246.
44). Lasser RA, Bossie CA, Zhu Y, Locklear JC, Kane JM. Long-acting risperidone in young adults with early schizophrenia or schizoaf-fective illness. Ann Clin Psychiatry. 2007; 19:65–71.
crossref
45). Emsley R, Oosthuizen P, Koen L, Niehaus DJ, Medori R, Rabinowitz J. Oral versus injectable antipsychotic treatment in early psychosis: post hoc comparison of two studies. Clin Ther. 2008; 30:2378–2386.
crossref
46). Emsley R, Medori R, Koen L, Oosthuizen PP, Niehaus DJ, Rabinowitz J. Long-acting injectable risperidone in the treatment of subjects with recent-onset psychosis: a preliminary study. J Clin Psychopharmacol. 2008; 28:210–213.
47). Chue P, Emsley R. Long-acting formulations of atypical antipsychotics: time to reconsider when to introduce depot antipsychotics. CNS Drugs. 2007; 21:441–448.
48). Franz M, Ranger J, Hanewald B, Gallhofer B, Lay B. Influences on Therapist's Decisions for Neuroleptic Treatment in Schizophrenia: The Role of Characteristics of the Patient and the Physician. Phar-macopsychiatry. 2012; 45:261–268.
crossref
49). Heres S, Schmitz FS, Leucht S, Pajonk FG. The attitude of patients towards antipsychotic depot treatment. Int Clin Psychopharmacol. 2007; 22:275–282.
crossref
50). 정인원, 현명호, 김진영, 배재남, 장홍석, 나동석 등. 정신보건시 설 재원자 및 시설 실태조사. 국가인권위원회;2008. p.25.
51). 박종익, 장홍석, 이진석, 이명수. 장기 입원의 구조적 원인과 지속 요인. 국가인권위원회;2008.
52). Bettoni M, Benigni B. Italian Law 180: the enduring principles it represents and the community of Arezzo. Ann Ist Super Sanita. 2009; 45:17–21.

Table 1.
Age and sex in patients with schizophrenia and their caregivers
Patients (N=614) Caregivers (N=365) p value
Sex, male (%) 336 (54.7) 120 (32.9) <0.001a
Age (yrs) 41.9±10.2 62.2±13.4 <0.001b

a : chi-square test

b : Independent-samples t-test

Table 2.
Clinical characteristics and medication history of patients with schizophrenia
Patients
Age of onset, years (N=577) 27.4±9.2
Hospitalization (N=604)
 0 77 (12.7)
 1 135 (22.4)
 2 108 (17.9)
 3 81 (13.4)
 4 68 (11.3)
 5 or more 135 (22.4)
History of medication discontinuation (N=610)
 Yes 272 (44.6)
 No 338 (55.4)
History of suicide attempt (N=607)
 Yes 205 (33.8)
 No 402 (66.2)
Types of hospital which provide patient treatment (N=603)
 Local clinics 157 (26.0)
 General hospital 100 (16.6)
 University hospital 68 (11.3)
 Psychiatric hospital 278 (46.1)
Current medication use (607)
 Yes 585 (96.4)
 No 22 (03.6)
Duration of current medication use (N=593)
 Less than 6 months 31 (05.2)
 From 6 months to 1 year 24 (04.0)
 From 1 year to 2 years 48 (08.1)
 More than 2 years 490 (82.6)
Frequency of drug administration (N=591)
 According to prescriptions (regularly) 467 (79.0)
 Once a day 104 (17.6)
 Once per 2 days 5 (00.8)
 Once per 3 days 6 (01.0)
 Irregularly 9 (01.5)
Dose actually administered, % (N=512) 91.3±17.1
 Reasons for non-adherence (N=265)
 Bothered by daily medications 74 (27.9)
 No effect 27 (10.2)
 Tried but couldn't 76 (28.7)
 Adverse effects 53 (20.0)
 I have no idea why I take medications 35 (13.2)
Table 3.
Attitude of patients with schizophrenia and caregivers on antipsychotic long-acting injections (LAIs)
Patients Caregivers p value
The importance of medications (N=600) (N=362) 0.042
 Not at all important 11 (01.8) 7 (01.9)
 Not important 12 (02.0) 9 (02.5)
No opinion 67 (11.2) 27 (07.5)
 Important 225 (33.7) 113 (31.2)
 Very important 285 (47.5) 206 (56.9)
Knowledge about LAI antipsychotics (N=605) (N=358) 0.005
 Yes 217 (35.9) 97 (27.1)
 No 388 (64.1) 261 (72.9)
Choice of medication (N=597) (N=355) 0.001
 Daily oral medications 387 (64.8) 189 (53.2)
 Injection once every 2 weeks 36 (06.0) 35 (09.9)
 Injection monthly 174 (29.1) 131 (36.9)
Expected effects (N=530) (N=345) 0.067
 Relapse prevention 148 (27.9) 111 (32.2)
 Increase of treatment effects 199 (37.5) 146 (42.3)
 Decrease of adverse effects 90 (17.0) 38 (11.0)
 Cost saving 39 (07.4) 21 (06.1)
Recommendation of LAIs (N=584) (N=318) 0.002
 Yes 278 (47.6) 202 (57.9)
 No 306 (52.4) 147 (42.1)
Reasons for not using 1 month LAIs (N=445) (N=259) <0.001
 I hate injection 144 (32.4) 41 (15.8)
 Oral medication is good enough 193 (43.4) 106 (40.9)
 Seems to be a lot of side effects 65 (14.6) 67 (25.9)
 Seems to be lack of effects 43 (09.7) 45 (17.4)
Compared to oral medications, reasons for not using injection (N=532) (N=318) <0.001
I can't trust the long-lasting effect 192 (36.1) 181 (56.9)
 Seems to be expensive 133 (25.0) 71 (22.3)
 Seems to be painful 91 (17.1) 22 (06.9)
 I hate buttock injections 50 (09.4) 12 (03.8)
 I hate Injection that feels like punishment 18 (03.4) 5 (01.6)

chi-square test

Table 4.
Comparison of clinical characteristics of patients and caregivers respectively on their preferences toward long-acting injections (LAIs) to oral antipsychotics
Patients C Caregivers
Hospitalization 0.699 0.015
History of medication discontinuation 0.014 0.058
Current medication use 0.034 0.015
Importance of medications 0.795 0.396
Reasons for non-adherence 0.010 0.412
Knowledge about LAIs 0.262 0.923
Reason for preference of injection <0.001 <0.001
Expected effects 0.031 0.730
Recommendation of LAIs <0.001 <0.001
Reasons for not using 1 month LAIs 0.001 <0.001
Compared to oral medications, reasons for not using LAIs <0.012 0.309

p value by chi-square test

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