Winter 2020 Issue
By Elisabeth Dietrich, MD
PSV Fall Meeting Poster Winner
At the Psychiatric Society of Virginia Fall Meeting, I presented my poster “Long-Acting Injectable Antipsychotics: A Review of Literature of Current Options for the Practitioner,” which I worked on with Dr. Ananda Pandurangi.
Although long-acting injectable (LAI) antipsychotics are some of the most effective forms of treatment for schizophrenia, they are currently underutilized. Barriers to use include a lack of practitioner knowledge about dose selection and pharmacokinetics, as well as false perceptions about efficacy and safety profiles. Given the development of newer formulations, the practitioner has a wide range of choices with regards to the agent, dosing, and frequency of injections.
In this poster presentation, the pharmacokinetics, pharmacology, and utility of each available LAI were briefly reviewed with the aim of familiarizing the practitioner with the newest available preparations. The pharmacokinetics and pharmacology were reviewed using the PubChem Compound Database and UpToDate. Current literature about the utility of each LAI was reviewed by conducting a PubMed search of studies assessing the outcomes of different LAIs and studies comparing LAI outcomes to those of oral preparations.
In assessing the utility of LAIs, patients benefit from lower rates of all-cause antipsychotic discontinuation and decreased hospital rates compared to those treated with oral preparations. Benefits also include stable blood levels in between injections, decreased risk of overdose, and improved ability to assess a patient's response to treatment. Several disadvantages stem from longer titration periods and extended time required to reach steady state.
While the cost of newer preparations can be burdensome, in the long-term treatment of schizophrenia, LAIs are no more costly than oral preparations. They offer the opportunity to enhance treatment adherence, reduce relapse and hospitalizations, enhance recovery, and contribute to improved quality of life.
I am grateful for the opportunity to present this work and to learn from physicians from across the state of Virginia during this hybrid conference. The Fall Meeting was an engaging and educational experience, and I enjoyed connecting with attending psychiatrists, residents from other programs, as well as medical students from Virginia.
February 19-20, 2021
Hilton Downtown Richmond
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