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Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia
Long-acting injectable antipsychotics can be a powerful strategy in helping patients to receive ongoing benefit from treatment. You might think that you have adequately explained this treatment option to patients, but they may not have understood. How can communication be improved? Read this Academic Highlights activity to find out.
Abstract
Acute and long-term objectives must be linked early in the treatment of schizophrenia. Maintenance therapy is pivotal in relapse prevention. Relapses are serious events that alter disease trajectory and are most often related to nonadherence. Patients with schizophrenia have a substantial risk of relapse, especially when they are nonadherent to antipsychotics. Because relapses are accompanied by structural brain changes, worsening symptoms, and increased treatment resistance when medication is resumed, clinicians must monitor nonadherence and offer strategies to avoid or improve it. Long-acting injectable (LAI) antipsychotics have the potential to reduce nonadherence, relapse, rehospitalization, and mortality, even among patients with first-episode schizophrenia and with comorbid substance use disorder. Long-acting formulations can be a very powerful strategy in helping to ensure that patients get the benefit of the medication they have been prescribed, as the use of LAIs is more easily monitored than oral medications due to the nature of their administration to patients. However, prescribers tend to believe that patients have negative attitudes about LAIs and avoid prescribing them. Patients should be offered the option of LAI antipsychotic treatment and should understand the logistics and the potential benefits of the regimen. LAIs differ regarding their initiation strategy, duration, and flexibility of injection intervals, in addition to the differences of the antipsychotic that the LAI formulation is based on. Presentation matters for LAI treatments to be accepted by patients and family members. Clinicians can use certain communication tools to improve their dialogue with patients about the benefits of switching from oral agents.
From the Series: Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia
To cite: Kane JM, Correll CU. Optimizing treatment choices to improve adherence and outcomes in schizophrenia. J Clin Psychiatry. 2020;80(5):IN18031AH1C.
To share: https://doi.org/10.4088/JCP.IN18031AH1C
© Copyright 2019 Physicians Postgraduate Press, Inc.
Target Audience
- Psychiatrists
- Nurse practitioners
- Physician assistants
Learning Objectives
After completing this educational activity, you should be able to:
- Monitor adherence to treatment in patients with schizophrenia
- Identify patients who would benefit from LAI treatment
- Address somatic and psychiatric comorbidities in the care of patients with schizophrenia
Support Statement
Supported by an educational grant from Indivior Inc.
Learning Objectives
After studying this article, you should be able to:
- Monitor adherence to treatment in patients with schizophrenia
- Identify patients who would benefit from LAI treatment
- Address somatic and psychiatric comorbidities in the care of patients with schizophrenia
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Release, Review, and Expiration Dates
This educational activity was published in September 2019 and is eligible for AMA PRA Category 1 Credit™ through October 31, 2021. The latest review of this material was August 2019.
Disclosure of Off-Label Usage
The chair has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this article.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
Acknowledgement
This Academic Highlights activity is derived from the teleconference series “Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia,” which was held in March and April 2019. This report was prepared and independently developed by the CME Institute of Physicians Postgraduate Press, Inc., and was supported by an educational grant from Indivior Inc.
Faculty Affiliation
John M. Kane, MD
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York
Christoph U. Correll, MD
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York
Financial Disclosure
All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.
Dr Kane is a consultant for and has received honoraria from Alkermes, Allergan, Genentech, Lundbeck, Intracellular Therapies, Janssen, Johnson & Johnson (J&J), Merck, Neurocrine, Otsuka, Pierre Fabre, Reviva, Roche, Sunovion, Takeda, and Teva; has received grant/research support from Otsuka, Lundbeck, and Janssen; is a member of the speakers/advisory boards for Alkermes, Intracellular Therapies, Lundbeck, Neurocrine, Otsuka, Pierre Fabre, Roche, Sunovion, Takeda, Teva, and Reviva; and is a stock shareholder of Vanguard Research Group and LB Pharma. Dr Correll is a consultant for and has received honoraria from Alkermes, Allergan, Angelini, Boehringer-Ingelheim, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; has received grant/research support from Janssen and Takeda; is a member of the advisory boards for Alkermes, Allergan, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, Merck, Neurocrine, Noven, Otsuka, Sunovion, Supernus, Takeda, and Teva; is a stock shareholder of LB Pharma; and has received other financial support from Janssen and Otsuka (expert testimony) and UpToDate (royalties).
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1 hour of Category I credit for completing this program.
MOC Approval Statement
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:
MOC Part II CME Activity
Psychiatry and Neurology
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation