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Switch to long-acting antipsychotics beneficial.


BERLIN -- A switch to long-acting second-generation injectable antipsychotics brought improved attitudes and beliefs regarding antipsychotic therapy among patients with schizo-affective disorder who already were stabilized on a single oral antipsychotic agent, Dr. Francesco Pietrini reported at the annual congress of the European College of Neuropsychopharmacology.

The conventional view has been that long-acting injectable antipsychotics are most appropriate as an alternative option for patients with poor adherence to oral antipsychotics. But this small observational study suggests that the switch is beneficial in a broader population, according to Dr. Pietrini of the University of Florence (Italy).

The 18 outpatients who participated in this 12-month, prospective, observational study showed significant improvements in many measures of psychopathology after the switch to long-acting injectable therapy. These benefits were accompanied by a steadily improving attitude toward treatment as reflected in rising scores on the Drug Attitude Inventory-10 (DAI-10).

All patients were stable at baseline on either oral olanzapine or oral paliperidone. They were then switched to the corresponding dose of the long-acting injectable formulation of the same drug and followed prospectively for 12 months.

Mean scores on the 0-10 DAI-10 rose from 3.22 at baseline to 6.56 after 6 months on a long-acting injectable antipsychotic and 8.11 at 12 months. These improvements in scores reflect the patients' growing endorsement of inventory items such as "taking medication will prevent me from having a breakdown," "my thoughts are clearer on medication," and "for me, the good things about medication outweigh the bad."

Scores on most measures of psychopathology improved from baseline during the first 6 months on long-acting therapy. The improvement was maintained but not expanded upon during the second 6 months. The exception was negative psychotic symptoms as assessed by the negative symptom scale of the Positive and Negative Syndrome Scale (PANSS), which didn't show significant improvement during the first 6 months but did in the second half of the year-long study (see chart).


Key clinical point: A switch to a long-acting injectable antipsychotic proved beneficial in multiple ways in patients with schizoaffective disorder who were stable on a single oral agent.

Major finding: Mean scores on the Drug Attitude Inventory-10 improved from 3.22 when patients were stabilized on an oral antipsychotic to 6.56 after 6 months on the long-term injectable formulation of the same drug and 8.11 after 12 months.

Data source: This was a 12-month observational study of 18 outpatients with schizoaffective disorder.

Disclosures: Dr. Pietrini reported having no financial conflicts regarding this study, which was conducted free of commercial support.
Switching to injectable therapy: The results

                                      Baseline   6 months   12 months

DAI-10                                   3.22       6.56       8.11
General psychopathology scale of        32.94      20.72      19.78
Positive symptoms scale of PANSS        14.22       8.67       8.61
Negative symptoms scale of PANSS        13.17       9.72       8.39
Montgomery-Asberg Depression Rating     12.72       6.28       4.11
Young Mania Rating Scale                 6.94       2.22       1.5

Note: The prospective, observational study involved 18

Source: Dr. Pietrini
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Author:Jancin, Bruce
Publication:Clinical Psychiatry News
Date:Jan 1, 2015
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