Serious Mental Illness, Substance Use Disorders, and Long-Acting Injectables in the Emergency Setting

CONFERENCE REPORTER

Psychiatric Times sat down with Angelo Chaia, MD, to discuss his American Psychiatric Association (APA) poster sessions, "Aripiprazole Lauroxil Treatment in Patients With Co-Occurring Stimulant Use Disorder and Bipolar or Schizophrenia Spectrum Disorder" and "Psychiatric Service Use in Patients With Serious Mental Illness and Substance Use Disorders: Aripiprazole Versus Paliperidone LAIs."

"The work that we're presenting has to do with analyzing a population of people with severe mental illness, like schizophrenia spectrum illness and bipolar disorder, who have comorbid substance use," shared Chaia. "We are trying to understand if there's a difference with certain interventions like long-acting injectables, specifically the difference between 2 long-acting injectables."

Chaia and investigators did a retrospective chart review to try to find a population of patients with severe mental illness and comorbid substance use disorder vs no comorbid substance use. Then, they evaluated patients who received paliperidone palmitate long-acting injectables compared with aripiprazole long-acting injectables, and how often they were rehospitalized, time to rehospitalization, and presentation to emergency department.

Both long-acting injectables worked similarly in time to rehospitalization; however, patients who received aripiprazole returned to the psychiatric emergency department more frequently.

The most common substances used were cannabis and methamphetamine; opioid use was less prevalent.

"From our perspective, and I think the perspective of many people practicing psychiatry, it can be disheartening to see how little attention is paid toward the substance use aspect of our patients with comorbid severe mental illness," shared Chaia. "Basically, trying to address both problems at the same time, rather than address them in a stepwise fashion, is really important."

Dr Chaia is a PGY-2 resident at Mount Sinai Beth Israel in New York City.

References

1. Chaia A, Renard K, Kymissis C. Aripiprazole Lauroxil treatment in patients with co-occurring stimulant use disorder and bipolar or schizophrenia spectrum disorder. Poster presented at: 2025 American Psychiatric Association Annual Meeting; May 17-22, 2025; Los Angeles, California.

2. Chaia A, Renard K, Kymissis C. Psychiatric service use in patients with serious mental illness and substance use disorders: aripiprazole versus paliperidone LAIs. Poster presented at: 2025 American Psychiatric Association Annual Meeting; May 17-22, 2025; Los Angeles, California.