New tool to improve patient understanding of long-acting injectable antipsychotic therapies (LAT) unveiled in April issue of Psychiatry 2009

'GAIN' offers structured approach for physicians to discuss potential reasons for use of LAT

Titusville, NJ, May 27, 2009 – A new instrument for improving patient understanding and acceptance of long-actingectable antipsychotic therapy (LAT inj) has been published in the April edition of Psychiatry 2009.1 This novel, psychosocial approach encompasses Goal setting, Action planning, Initiating treatment, and Nurturing motivation (GAIN) through the use of a clinical discussion tool.

Nonadherence to oral antipsychotic medications is one of the most significant clinical challenges in psychiatry and behavioral medicine, with rates of nonadherence estimated to be as high as 50 and 75 percent in the first and second years of treatment.2,3 Despite evidence suggesting that continuous antipsychotic treatment is more effective than interrupted treatment, and the fact that LAT is strongly recommended in many cases4, the prescription of LAT remains low in the United States. GAIN was developed to assist physicians and other clinicians by providing them with an effective approach to engage patients in a discussion of the consideration of LAT and in overcoming any related barriers.

"Long acting injectable therapies have typically been reserved for the most difficult patients where nonadherence to medication has been identified as a primary obstacle, usually because of repeated relapses. Utilizing long-acting therapies administered by a healthcare professional more widely has an advantage over daily oral formulations in that healthcare professionals will know when their patients are not taking their medications before the consequences of nonadherence occur. Early intervention may well prevent relapse," said Nina R. Schooler, Ph.D. Professor of Psychiatry & Behavioral Sciences at State University of New York Downstate Medical Center. "However, it is often difficult for clinicians to discuss injectable medications with patients because of reluctance to take injections and stigma. With GAIN, we now have an effective tool to use in approaching a recommendation and have the possibility to help more patients with schizophrenia as we work together to control their symptoms."

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Most Psychiatrists Unlikely To Use Depot Antipsychotics

Innovative strategies to train more psychiatrists and their staff in the use of depot antipsychotics may help promote their use in different settings and in patients whoare less severely ill but are still medication nonadherent.

Less than 20 percent of psychiatrists prescribed a long-acting depot antipsychotic medication for patients with schizophrenia who were nonadherent with the original medication.

That was the finding of a nationwide survey by researchers with the American Psychiatric Institute for Research and Education (APIRE), Columbia University College of Physicians and Surgeons, and the University of Pennsylvania School of Social Policy and Practice. The study was conducted between September 2003 and January 2004.

Moreover, the decision to use depot medications appears to be a function of patient, physician, and practice-setting characteristics. For instance, initiation of depot medication was significantly and positively associated with public insurance, prior inpatient admission, proportion of time nonadherent, average or above average intellectual functioning, and living in a mental health residence. Psychiatrists who were optimistic about managing nonadherence were also more likely to prescribe long-acting antipsychotics for nonadherent patients.

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