Changing the Guessing Game in Schizophrenia Treatment

With most medical diseases or illnesses, clinicians know that treatment adherence is critical for disease management.¹ Schizophrenia, like other mental illnesses, can present challenges when considering treatment options due to adherence issues, lifestyle concerns, and stigma.^1,2 Research has shown that when patients “feel” better they are more likely to discontinue medical intervention.¹ For adults living with schizophrenia, they often experience lack of insight and the impaired ability to understand and perceive their serious mental illness.³ Oftentimes, this results in not taking medication as prescribed or discontinuing medication without the direction of a doctor, which can result in serious consequences, such as repeated relapse.⁴

Long-acting injectable (LAI) medications help providers map out a treatment plan and provide greater assurance that a patient will receive a medication continuously with fewer opportunities to miss a dose, and if they do, clinicians will be aware of a missed visit or injection, since LAIs are professionally administered.²

Quite often in my role as Director of Pharmacy I am asked, “Will my medication help me feel normal?” and “How will this work if I don’t take it every day?” Traditionally, we see patients on daily oral medications relapse several times due to nonadherence, which can result in multiple hospital admissions, possible loss of wages for themselves or caregivers during these stays, and permeating the general stigma associated with mental health disorders.⁵ In my opinion, delaying relapse is essential to reducing these burdens faced by patients. In 2013, the overall economic burden of schizophrenia in the United States was estimated at $155.7 billion, and the excess direct healthcare costs incurred by treating patients exceeded $37 billion.⁶

LAIs can change this course. With LAIs, we can remove some of the burden that comes with traditional oral therapy, such as not having to remember to take medications every day.⁷ LAIs delay time to relapse in adult patients living with schizophrenia.^2,7

While using LAIs will increase the pharmacy budget, there is no denying the overall benefit when you look at the total system and the time and costs associated with repeated relapses. In my role, I see the impact of avoiding additional healthcare, societal, and personal costs associated with repeated relapses. In addition, and perhaps more importantly, I’ve found that improving the patient experience, delaying relapse, and avoiding some of the consequences of nonadherence make spending more on a medication worth it. 

Within the pharmacy setting, we know that receipt of oral medication offers no guarantee that our patients take even one dose. However, because LAIs are professionally administered, there is no question as to whether there is medication on board. In addition, several community pharmacies offer injection administration on-site, allowing for administration by a trusted healthcare provider. As pharmacists, being a part of the treatment team for an adult living with schizophrenia is helpful because we can be an added layer of support in providing information about medications or identifying safety concerns, such as adverse events. 

The consideration of LAIs by the National Council for Behavioral Health and the American Psychiatric Association in their guidance and guideline for schizophrenia treatment can increase clinician awareness of the wealth of evidence and recommended use of these medications that will ultimately benefit the patients who use them.^2,8 It is my hope that as a body of healthcare providers we will take advantage of an opportunity to understand the treatment options available to potentially offer our patients living with schizophrenia a chance to experience the journey to mental health wellness.
 

Britney Woods, PharmD, is a proud graduate of Xavier University of Louisiana College of Pharmacy.  She has over a decade of professional experience, with the last 6 years focused on behavioral health. She currently serves as a Director of Pharmacy at a mental health facility in a major metropolitan city. Britney Woods partnered with Janssen Pharmaceuticals, Inc., in the development of this byline article. She has been paid an honorarium for her time. 
 

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