The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia

Figures & data

Table 1 Phase of disease: effects of SGA LAIs on patient and caregiver needs, expectations, and personal experiences

First-episode schizophrenia		Chronic schizophrenia
Personal experiences	Needs and expectations (toward illness and care)	Personal experiences	Needs and expectations (toward illness and care)
-Poor awareness/uncertainty about the impact of the illness - Denial of the illness -Skepticism of establishing a therapeutic relationship/receiving AP treatment -Stress (for first contact with MHS, hospitalization, ER presentations) -Neurocognitive deficits	-Hopes of returning to normality/recovery -Avoid illness engulfment/self-stigmatization -Fewer treatment-related adverse effects/visits to MHS -Greater treatment satisfaction/SWB	-Depressive symptoms (for stronger perceived stigma/greater insight about the illness) -Self-harm, difficulties with personal relationships, loss of self-esteem, and decreased QoL (for frequent relapses, duration of illness) -Stress (for emotional and financial impact of frequent relapses)	-Fewer relapses -Improvement of social and work functioning -More information about treatments and advantages/goals of psychopharmacological treatment -Social integration with specific interventions
Effects of SGA LAIs		Effects of SGA LAIs
Better clinical outcome (eg, relapse reduction, fewer positive symptoms) vs oral formulations Reduction of hospitalizations/treatment discontinuations (lower level of stress and disease burden; greater perceived normality and hope for recovery) Neuroprotective effect vs FGAs More favorable pharmacokinetics (better tolerability and SWB; fewer treatment self-discontinuations) Reduction in treatment intensity (maintenance of employment and social life, reduced need of frequent visits to MHS) Less monitoring of treatment adherence (improved therapeutic alliance; greater stability and family climate of normality)		Long-term control of psychotic and affective symptoms Reduction in treatment intensity (more focus on life goals, better self-confidence and hope, limited stigma and self-stigma, better social and work functioning, reduction of stress, greater involvement in personalized psychosocial interventions) Relapse reduction (better patient self-esteem) No unintentional or deliberate overdose (reduced risk of self-harm)

Abbreviations: AP, antipsychotic; FGAs, first-generation antipsychotics; MHS, mental health services; QoL, quality of life; SGA LAIs, second-generation antipsychotics long-acting injectable; SWB, subjective well-being.

Table 2 Adherence to treatment: effects of SGA LAIs on patient and caregiver needs, expectations, and personal experiences

Adherent patients		Partially adherent patients		Nonadherent patients
Personal experiences	Needs and expectations (toward illness and care)	Personal experiences	Needs and expectations (toward illness and care)	Personal experiences	Needs and expectations (toward illness and care)
- Burden of frequent visits to MHS -Constraints of taking pills in front of other (eg, patients with privacy concerns)	-Treatment deintensification -Flexible delivery of treatment - Fewer treatment-related SEs -Greater treatment satisfaction/better SWB	- Prior negative experience with AP treatments -Frequent disputes with caregivers about taking pills every day/ more than once a day	-More effective treatment - Need to be seen more often by MHS -No need to discuss nonadherence issues with clinicians -Fewer treatment-related SEs -Greater treatment satisfaction	-Complete lack of insight - Denial of illness - Traumatic experience with hospital admission and AP treatment (eg, high dose with significant sedative action) -Frequent disputes with caregivers about taking pills every day/ more once a day -Reluctance to see the physician	- Appropriate AP treatment -Greater treatment satisfaction/better SWB and QoL
Effects of SGA LAIs		Effects of SGA LAIs		Effects of SGA LAIs
More favorable pharmacokinetic and pharmacodynamic profile (better tolerability, SWB, treatment satisfaction, and QoL, lower risk of overtreatment, quaternary prevention) Reduction in treatment intensity (better hope and social acceptability, feeling of being on the road to recovery, greater involvement in life, no need of frequent visits) No need to take pills in front of others		More favorable pharmacokinetic and pharmacodynamic profile (better tolerability and SWB) Better clinical outcome (eg, relapse reduction, fewer positive symptoms) vs oral formulations Regular interactions between patient and MHS (reassurance of to receiving the best support possible) Less monitoring of treatment adherence (more time used to evaluate patient’s needs, greater empowerment) Reduction of disputes between patients and caregivers about taking medication		More favorable pharmacokinetic and pharmacodynamic profile (better tolerability and SWB) Guaranteed administration Earlier detection of possible relapses due to nonadherence, which can be followed up quickly Wider window of opportunity for caregivers to resume AP treatment, due to significant delay in time to relapse when treatment discontinued or withdrawn Reduction of disputes between patients and caregivers about taking medication

Abbreviations: AP, antipsychotic; MHS, mental health services; QoL, quality of life; SEs, side effects; SGA LAIs, second-generation long-acting injectable antipsychotics; SWB, subjective well-being.

Table 3 Level of functioning: effects of SGA LAIs on patient and caregiver needs, expectations, and personal experiences

Low-functioning patients		High-functioning patients
Personal experiences	Needs and expectations (toward illness and care)	Personal experiences	Needs and expectations (toward illness and care)
-Feelings of frustration, anger, self-blame, and inability to lead a productive life -Tendency to avoidance and isolation -Regressive need for overall care	-Recovery of previous functioning -Establishment of prompt and adequate treatment -Treatment de-intensification	-Poor awareness of the implications of nonadherence -Stigmatization of oneself and MHS -Constraints of taking daily oral treatment (patients feel more ill, less “normal”, or less “free“)	-Fewer treatment-related SEs -Greater treatment satisfaction/SWB -Treatment deintensification
Effects of SGA LAIS		Effects of SGA LAIs
Better tolerability and reduced variations in symptom control Lower relapse rates vs oral APs (preventing functional decline) Less negative impact on cognitive aspects vs FGA-LAIs (more productive involvement in activities related to rehabilitation) Progressive improvement of positive symptoms, uncontrolled hostility/excitement, anxiety/depression, personal and social functioning, health-related QoL Decreasing family burden for constant monitoring of treatment adherence		Supportive function in the process of breaking the spiral of desocialization and favoring the recovery process Reduction in treatment intensity (greater flexibility and freedom, improved QoL, reduction of frequency of MHS visits) No need to take medication on a daily basis (attention moved to other aspects of daily life, lower risk of stigmatization of oneself and others)

Abbreviations: APs, antipsychotics; MHS, mental health services; QoL, quality of life; SEs, side effects; SGA LAIs, second-generation long-acting injectable antipsychotics; SWB, subjective well-being.