Samalin L, Abbar M, Courtet P, Guillaume S, Lancrenon S, Llorca P-M
CHU Clermont-Ferrand, EA U7280, Université d'Auvergne, Clermont-Ferrand, France.
CHU Caremeau, Nîmes, France.
Encephale. 2013 Dec;39 Suppl 4:189-203. doi: 10.1016/S0013-7006(13)70121-0.
Compliance is often partial with oral antipsychotics and underestimated for patients with serious mental illness. Despite their demonstrated advantages in terms of relapse prevention, depot formulations are still poorly used in routine. As part of a process to improve the quality of care, French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) Task Force elaborated a Formal Consensus for the prescription of depot antipsychotics in clinical practice.
The Task Force recommends as first-line choice, the use of long-acting injectable (LAI) second-generation antipsychotics in patients with schizophrenia, schizoaffective disorder and delusional disorder. They can be considered as a second-line option as a monotherapy to prevent manic recurrence or in combination with mood stabilizer to prevent depressive recurrence in the maintenance treatment of bipolar disorder. LAI second-generation antipsychotics can also be used after a first episode of schizophrenia. Depot neuroleptics are not recommended during the early course of schizophrenia and are not appropriate in bipolar disorder. They are considered as a second-line option for maintenance treatment in schizophrenia.
LAI formulations should be systematically proposed to any patients for whom maintenance antipsychotic treatment is indicated. LAI antipsychotics can be used preferentially for non-compliant patients with frequent relapses or aggressive behaviors.
A specific information concerning the advantages and inconveniences of the LAI formulations, in the framework of shared-decision making must be delivered to each patient. Recommendations for switching from one oral/LAI form to another LAI and for using LAI antipsychotics in specific populations (pregnant women, elderly patients, subjects in a precarious situation, and subjects having to be treated in a prison establishment) are also proposed.
口服抗精神病药物的依从性往往不完全，且严重精神疾病患者的依从性被低估。尽管长效制剂在预防复发方面具有明显优势，但在常规治疗中仍使用不足。作为提高护理质量过程的一部分，法国生物精神病学和神经精神药理学协会（AFPBN）特别工作组制定了临床实践中长效抗精神病药物处方的正式共识。
特别工作组建议，对于精神分裂症、分裂情感性障碍和妄想性障碍患者，首选使用长效注射（LAI）第二代抗精神病药物。在双相情感障碍的维持治疗中，它们可作为单药预防躁狂复发的二线选择，或与心境稳定剂联合使用预防抑郁复发。LAI第二代抗精神病药物也可在精神分裂症首次发作后使用。长效抗精神病药物不推荐在精神分裂症病程早期使用，也不适用于双相情感障碍。它们被视为精神分裂症维持治疗的二线选择。
对于任何需要进行抗精神病药物维持治疗的患者，都应系统地推荐LAI制剂。LAI抗精神病药物可优先用于依从性差、频繁复发或有攻击行为的患者。
在共同决策的框架内，必须向每位患者提供有关LAI制剂优缺点的具体信息。还提出了从一种口服/LAI剂型转换为另一种LAI剂型以及在特定人群（孕妇、老年患者、处境不稳定的受试者以及必须在监狱机构接受治疗的受试者）中使用LAI抗精神病药物的建议。
