The use of long-acting injectable antipsychotic medication

摘要

Evidence supports the use of long-acting injectable (LAI) antipsychotics in the treatment and prevention psychosis, but these formulations remain under-used in the UK. Overall, LAIs offer many advantages and the advent of second-generation LAIs increased interest in injectables as these newer drugs offer similar benefits to their oral equivalents. LAIs should be one of the options discussed with patients requiring long-term treatment. Soon after the introduction of antipsychotics in the 1950s, poor adherence to oral medication was found to be a critical issue that compromised the efficacy of pharmacotherapy. This stimulated the development of long-acting injectables (LAIs) or 'depot antipsychotic injections'. The first depot antipsychotic injections were fluphenazine enanthate (1966) and fluphenazine decanoate (1968). Clinical trial results showed a dramatic reduction in the morbidity of schizophrenia for those taking these formulations (Johnson, 2009). The next two decades saw the licensing of other first-generation LAIs, resulting in an important contribution to the development of community psychiatry. In many respects their introduction served to buttress the case for the on-going development of community mental health nursing. Their use also stimulated the development of depot clinics where community mental health nurses administered LAIs to dozens of patients in the same day. In these depot clinics, however, there was scant interaction with patients and this proved to be a negative outcome of their use.