Early use of long-acting injectable antipsychotics in bipolar disorder type I: An expert consensus.

IF 5 2区 医学 Q1 CLINICAL NEUROLOGY Bipolar Disorders Pub Date : 2024-10-22 DOI:10.1111/bdi.13498
Eduard Vieta, Mauricio Tohen, Diane McIntosh, Lars Vedel Kessing, Martha Sajatovic, Roger S McIntyre
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Abstract

Introduction: Long-acting injectable antipsychotics (LAIs) are not routinely offered to patients living with bipolar disorder type I (BP-I), despite widespread evidence that supports their benefits over oral antipsychotics, particularly in early disease.

Methods: A round-table meeting of psychiatrists convened to discuss barriers and opportunities and provide consensus recommendations around the early use of LAIs for BP-I.

Results: LAIs are rarely prescribed to treat BP-I unless a patient has severe symptoms, sub-optimal adherence to oral antipsychotics, or has experienced multiple relapses. Beyond country-specific accessibility issues (e.g., healthcare infrastructure and availability/approval status), primary barriers to the effective use of LAIs were identified as attitudinal and knowledge/experience-based. Direct discussions between healthcare providers and patients about treatment preferences may not occur due to a preconceived notion that patients prefer oral antipsychotics. Moreover, as LAIs have historically been limited to the treatment of schizophrenia and the most severe cases of BP-I, healthcare providers might be unaware of the benefits LAIs provide in the overall management of BP-I. Improved treatment adherence associated with LAIs compared to oral antipsychotics may support improved outcomes for patients (e.g., reduced relapse and hospitalization). Involvement of all stakeholders (healthcare providers, patients, and their supporters) participating in the patient journey is critical in early and shared decision-making processes. Clinical and database studies could potentially bridge knowledge gaps to facilitate acceptance of LAIs.

Conclusion: This review discusses the benefits of LAIs in the management of BP-I and identifies barriers to use, while providing expert consensus recommendations for potential solutions to support informed treatment decision-making.

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躁郁症 I 型早期使用长效注射抗精神病药:专家共识。
导言:尽管有广泛的证据表明长效注射抗精神病药物(LAIs)比口服抗精神病药物更有疗效,尤其是在疾病早期,但长效注射抗精神病药物并没有成为I型双相情感障碍(BP-I)患者的常规药物:方法:召开一次精神科医生圆桌会议,讨论障碍和机遇,并就早期使用LAIs治疗I型双相情感障碍提出一致建议:结果:除非患者症状严重、口服抗精神病药物的依从性不达标或经历多次复发,否则很少使用LAIs治疗BP-I。除了特定国家的可及性问题(如医疗基础设施和可用性/批准状态)外,有效使用LAIs的主要障碍还包括态度和知识/经验。由于先入为主地认为患者偏好口服抗精神病药物,医疗服务提供者与患者之间可能不会就治疗偏好进行直接讨论。此外,由于LAIs历来仅限于治疗精神分裂症和最严重的BP-I病例,医疗服务提供者可能没有意识到LAIs在BP-I整体治疗中的益处。与口服抗精神病药物相比,LAIs 可提高治疗依从性,从而改善患者的预后(如减少复发和住院治疗)。让所有利益相关者(医疗服务提供者、患者及其支持者)参与到患者的治疗过程中,对于早期和共同决策过程至关重要。临床和数据库研究有可能弥补知识差距,促进对LAIs的接受:本综述讨论了 LAIs 在 BP-I 管理中的益处,并指出了使用 LAIs 的障碍,同时为支持知情治疗决策的潜在解决方案提供了专家共识建议。
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来源期刊
Bipolar Disorders
Bipolar Disorders 医学-精神病学
CiteScore
8.20
自引率
7.40%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.
期刊最新文献
Issue Information Early use of long-acting injectable antipsychotics in bipolar disorder type I: An expert consensus. Psychotherapy online: Bridging the gap between recommendations and reality Commentary on ‘Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course and treatment considerations’ by Temes et al. The Holy Grail revisited: What works for whom?
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