Length of first admission for schizophrenia predicts choice of antipsychotic | Tech US News


COLORADO SPRINGS, Colo. — The use of long-acting injectable (LAI) antipsychotic therapies instead of oral medications for schizophrenia was associated with demographic and clinical factors, a single-center retrospective cohort study found.

Younger age (OR 0.97, 95% CI 0.95-0.99, p=0.01) predicted which patients received antipsychotic treatment with LAI, reported dr. Emily Groenendaal of New York School of Medicine at Valhalla.

Length of first admission also predicted LAI use (OR 1.06, 95% CI 1.03-1.09, p<0.001), Groenendaal said during a presentation at the 2022 Institute of Neuroscience Education Congress.

Patients receiving LAI treatment had greater disease severity observed after a longer initial admission time (LAI group 23.0 days vs. oral group 13.0 days, p<0.001) and higher complication rates (LAI group 30.1% vs. oral group 6.5%, p<0.001), Groenendaal said.

Neither cost nor socioeconomic status likely influenced these findings because more than 90% of the patient population had public insurance and there were no differences between groups in terms of insurance status, she noted.

“We had many direct indicators of disease severity,” Groenendaal said MedPage Today. “For example, what you see most in the literature is length of first admission – if you have a long-term admission to an inpatient unit, that’s a direct indicator of increased severity of illness – but also things like complicated discharge if you’ve been set up with something more intensive than just outpatient therapy .”

“To start with the predictors, we found that the only predictors of receiving LAI were younger age and longer length of admission,” she said. “That was nice, because a longer length of admission indicates a greater severity of the disease, if you have a greater severity of the disease – more problems with medication adherence – you should definitely receive LAI. The literature is moving in the direction of offering LAI to younger and younger patients. to mitigate the course of the disease .”

The researchers also analyzed the predictors of patients using first- or second-generation antipsychotics, either LAIs or oral. Older age was reported to be a significant predictor of first-generation LAI use, and this group was more likely to have a co-occurring substance use disorder.

Among first- and second-generation oral antipsychotics, first-generation oral therapies were used more often by older patients and women. Patients using first-generation oral therapy were also more likely to have complicated discharges and longer first admissions.

Groenendaal noted that it’s possible that providers of older patients who have been taking first-generation antipsychotics — especially those with well-controlled symptoms — may not want to switch those patients to second-generation antipsychotics.

“In terms of first generation receiving LAI, we found that actually older age is a significant predictor, which is not really a very good thing because first generation can generally have higher EPS rates. [extrapyramidal symptoms] or movement disorders,” Groenendaal said.

To identify predictors, in 2019 Groenendaal and coauthors compared the medical charts of 246 patients diagnosed with schizophrenia or schizoaffective disorder at Westchester Medical Center in Valhalla, New York.

The cohort was diagnosis matched between patients receiving LAI antipsychotics (n=123) and patients receiving oral antipsychotics (n=123). All sociodemographic and clinical factors, including disease severity indicators, were collected from the patients’ medical records.

The findings highlighted several revelations about the institution’s prescribing patterns for this patient population and sparked conversations about how decisions are made when prescribing patients with LAIs or oral antipsychotics, Groenendaal noted.

For patients with severe disease, LAIs may be the best choice, “but we are educators [and] we should definitely present all options to our patients and somehow help them choose,” she said.

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    Michael DePeau-Wilson is a business and investigative reporter for MedPage Today. It covers psychiatry, prolonged covid and infectious diseases, among other important US clinical news. It follows


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