Optimizing Management of Schizophrenia with Long-acting Injectables - Episode 9

Advice for Clinicians Treating Schizophrenia

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Sanjai Rao, MD, DFAPA, and Kimberly Garcia, DNP, CRNP provide some advice to clinicians on explaining schizophrenia to patients and caregivers to achieve understanding and therapy adherence.

Sanjai Rao, MD, DFAPA: Maybe we can conclude by talking about advice for clinicians on how they approach this with patients, how they approach this with caregivers, how can we better help our patients understand the disease and understand adherence to therapy—advice to clinicians in general on this whole idea.

Kimberly Garcia, DNP, CRNP: My advice to clinicians would be to get to know your patients, their family members, their support system, their living environment. That sounds hypothetical and whatnot, but over time that’s exactly what I’ve been able to do. My medication management appointments are 15 minutes, so I have to use my time wisely. But we have the responsibility to provide our patients with all their options. Let them know what the benefits are—perhaps this could delay the time to relapse. Let them understand what can happen to an individual who has chronic schizophrenia that’s not optimally managed and how that relies on a nice therapeutic relationship with both of us. It’s going to take a village to get the individual back where they’d like to be, to give them the best opportunity. The other thing I would definitely say is—and I really believe this—that if we want to change someone’s life in psychiatry, start a long-acting injectable [LAI] early in the course of illness for a person who’s been diagnosed with schizophrenia.

Sanjai Rao, MD, DFAPA: Yeah, I agree. I’ll just add that I’ve had a fair number of clinicians say to me, “I don’t think my patients will accept this treatment,” or they’re scared of injections, or whatever else it is that we’ve been taught to believe. It’s interesting because we do have literature on this. We clinicians often think patients won’t accept LAIs. If we present it to them in a fair way, highlighting not just the risks but also the benefits, more of them will take LAIs than we think. In addition to what you said, that’s been my advice to clinicians: “I know you don’t think they’ll accept it but why don’t you just give it a try. Ask them, and you may be surprised.” I’ve had a number of them come back who were surprised. They say, “I didn’t think this guy was going to take it, but I asked him and he actually did agree to take it.”

Kimberly Garcia, DNP, CRNP: Yes. I’ll have patients or their therapist tell me, “Good luck. This person will never take the injection—never.” The next thing you know, they’re like, “I can’t believe it. It’s already scheduled. They’re coming in tomorrow.” They’re amazed. But it’s all about the presentation. If we present it as an opportunity, not the last resort, not a punishment. I’m cautious with the terminology I use. I’ll make sure to not say things like your shot. I will say your injection. I’m also very cautious with providing them with a realistic picture of what that looks like.

You mentioned earlier that some of the injectables require 2 doses to get those concentrations up a little higher. It’s interesting. If you tell a patient you’re going to get 1 injection every 28 days, and then you’re giving them an appointment for 2 injections in 2 weeks, they look at you like, “Wait a minute, what are you talking about? This isn’t consistent with what we discussed.”That can have a huge impact on therapeutic rapport with our patients, and they’ll lose that confidence in us. I’m very realistic with them, and try to give a very clear picture of what they can expect from my experiences with working with patients.

Sanjai Rao, MD, DFAPA: Just from this last hour, I can tell that you and I could probably talk about this for the next 2 hours and not run out of things to talk about with regard to LAIs and the treatment of our patients. But sadly we’re out of time, so I’m going to have to close. I want to say it’s been a pleasure having this conversation with you.

Kimberly Garcia, DNP, CRNP: Thank you. I’ve enjoyed it. Thank you so much for this opportunity.

Sanjai Rao, MD, DFAPA: Absolutely. Thank you all for watching this Psychiatric Times®PsychView series from MJH Life Sciences™. We hope you found this to be valuable to your clinical practice and that you’ll join us again in the future.

Transcript edited for clarity.