Seize opportunities to improve long-term outcome

Given the strong evidence that long acting treatment improves functional outcomes, we need to be more convincing in advocating its use when talking to patients with schizophrenia and their families. That was the take-home message from Christoph Correll (Charité University Hospital, Berlin, Germany) at an ECNP 2020 Virtual satellite symposium.

 

More and earlier use of long acting therapies (LATs) will help preserve functioning and prevent secondary treatment resistance,1 Professor Correll told the meeting.  Compared with oral medication, LATs ensure drug delivery and reduce risk of relapse and mortality.1 There is also benefit from psychosocial interventions, he argued, and this was a theme explored earlier in the symposium by Silvana Galderisi (University of Campania Luigi Vanvitelli, Naples, Italy) who spoke of the need for a holistic approach to the treatment of schizophrenia.

 

Presentation matters

In support of his view that health care professionals could do more to encourage use of LATs, Professor Correll referred to an analysis of 33 conversations between a psychiatrist and patients with schizophrenia.2 Only 9% of content focused on the benefits of an LAT; and only 33% of patients accepted its recommendation. Yet a subsequent interview found that 96% of patients who initially declined LAT were in fact receptive when the idea was more positively presented.

Focused staff training has the potential to substantially enhance the use of LAI antipsychotics

And to provide evidence that LATs could be widely accepted, he presented data from the recruitment phase of a recent US multicenter study.3 This involved a preparatory two-day training program for healthcare professionals and participating sites. This covered the rationale for LATs as relapse prevention in early psychosis, shared decision making, role playing, and solutions for overcoming logistical barriers. As a result, 77% of patients with first episode psychosis who were eligible for the trial received at least one long-acting injection.

Intervention early makes a difference

Earlier in the symposium, Ana Catalan (Basurto University Hospital, Bilbao, Spain) emphasized the importance of individualized treatment plans, of considering maintenance antipsychotic treatment, and of not forgetting psychosocial and psychotherapeutic interventions. She also strongly argued the case for early intervention services.

Meta-analysis of ten randomized clinical trials showed that early intervention was superior to treatment as usual in rates of therapy discontinuation, involvement in school or work, and severity of both positive and negative symptoms.4

 

Educational financial support for this satellite symposium at ECNP Virtual 2020 was provided by Janssen Pharmaceutica NV

 

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

Referencer

1. Correll C U, Lauriello J. J Clin Psychiatry 2020;81(4):MS19053AH5C

2. Weiden PJ et al. J Clin Psychiatry 2015;76:684-90

3. Kane JM et al. J Clin Psychiatry 2019;80:18m12546

4. Correll CU et al. JAMA Psychiatry 2018; 75:555-565

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