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

Autor: Vieta E; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain., Tohen M; Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Science Center, Albuquerque, New Mexico, USA., McIntosh D; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada., Kessing LV; Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Sajatovic M; Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA., McIntyre RS; University of Toronto, Toronto, Ontario, Canada.; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Bipolar disorders [Bipolar Disord] 2024 Oct 22. Date of Electronic Publication: 2024 Oct 22.
DOI: 10.1111/bdi.13498
Abstrakt: 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.
(© 2024 The Author(s). Bipolar Disorders published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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