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Article Abstract

Long-acting injectable antipsychotics (LAIs) can help prevent relapse and rehospitalization, reduce symptoms, and improve functioning, including in the early illness phases when treatment discontinuations are particularly high. However, LAIs are underused, possibly due to a lack of knowledge and experience. A major benefit of LAIs is in promoting adherence and signaling nonadherence immediately. To adequately use LAIs, patients’ concerns need to be elicited and addressed. This may include potential worries about increased appointments (which may provide welcome support), conversion from oral to LAI formulation (which generally can be managed easily), injection site pain (which is usually mild and transient), inability to stop LAIs abruptly when side effects occur (which may be reduced due to less peak-level and withdrawal related symptoms and which generally can be managed during the continued presence of antipsychotics), stigma (which is reduced by making LAIs a treatment option for all patients) and cost (which needs to be assessed/managed). Mental health team member concerns that may need to be addressed include lack of experience and education in using LAIs, lack of organizational structures for providing injections, underappreciation of the high rates of nonadherence and related unnecessary medication switches and destabilization, underappreciation of patients’ positive attitudes towards LAIs once they tried them, and consideration of LAIs only for the sickest patients who may oppose them. Treatment teams need to appreciate the potential benefits of LAIs so that they can explain the pros and cons of this formulation to patients who may benefit from this available treatment option.

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