Transitioning to Long-Acting Injectables in Schizophrenia


Bryce Reynolds, MD, reviews how long-acting injectable medications for schizophrenia could enhance outcomes in a patient who has been unsuccessful on oral therapy for many years.

Bryce Reynolds, MD: Let me go over another scenario. This is No. 2, in which we have a patient who’s recently been switched to a long-acting injectable from a po [oral] medication. This is not a newly diagnosed patient but a 37-year-old woman. She was diagnosed with schizophrenia 10 years ago, and she’s on oral therapy, but she’s been on and off the oral therapy in that time. She forgets to take her medications but has been resistant to a long-acting injectable in the past. Give me some ideas as to what you would do with this patient in regard to a long-acting injectable, Hannah.

Hannah Phillips-Hall, MSN, PMHNP-BC: It’s important to identify what you said, which is that she’s been ill for about a decade, correct?

This is a patient who may have had some prior negative experience in the past. Maybe she’s been hospitalized and potentially received an emergency treatment order [ETO]. Maybe her association with the long-acting injectable therapy is with that ETO. That’s where it’s our job to be proactive and dispel some of those misconceptions for the patient.

Additionally, given that time period, we cannot just say 1 class of long-acting injectables is better than another. We have a multitude of treatment options available because all our patients are unique. But perhaps she had a negative experience with 1 of the sesame oil–based products that may have resulted in some pain. Perhaps it had been offered to her only within the framework of someone saying, “You’re not on your oral meds.” People can take that as a failure. They may feel, “I failed. I’m not good. Therefore, I’m now on this shot.” They view it in that framework, rather than seeing the empowering aspect of a long-acting injectable therapy.

Bryce Reynolds, MD: I agree with you on that. This illness precludes people from taking po [oral] medication. When you have decreased insight, cognition, and motivation, it’s inherent in the illness. We as treatment providers need to provide tools to counteract these very symptoms that the illness causes. Those include cognitive difficulties, motivation, and that lack of insight. That’s where long-acting injectable comes into play.

Again, this is another situation in which we’re talking about starting a person on a long-acting injectable during COVID-19 [coronavirus disease 2019]. You bring up a point that her past experience may come into play. But in any case, she’s not fully adherent with po [oral] medications. This is 1 way to ensure that she’s getting a consistent amount of medication into her system.

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