Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.
J Clin Psychiatry. 2019 Sep 17;80(5):IN18031AH1C. doi: 10.4088/JCP.IN18031AH1C.
Acute and long-term objectives must be linked early in the treatment of schizophrenia. Maintenance therapy is pivotal in relapse prevention. Relapses are serious events that alter disease trajectory and are most often related to nonadherence. Patients with schizophrenia have a substantial risk of relapse, especially when they are nonadherent to antipsychotics. Because relapses are accompanied by structural brain changes, worsening symptoms, and increased treatment resistance when medication is resumed, clinicians must monitor nonadherence and offer strategies to avoid or improve it. Long-acting injectable (LAI) antipsychotics have the potential to reduce nonadherence, relapse, rehospitalization, and mortality, even among patients with first-episode schizophrenia and with comorbid substance use disorder. Long-acting formulations can be a very powerful strategy in helping to ensure that patients get the benefit of the medication they have been prescribed, as the use of LAIs is more easily monitored than oral medications due to the nature of their administration to patients. However, prescribers tend to believe that patients have negative attitudes about LAIs and avoid prescribing them. Patients should be offered the option of LAI antipsychotic treatment and should understand the logistics and the potential benefits of the regimen. LAIs differ regarding their initiation strategy, duration, and flexibility of injection intervals, in addition to the differences of the antipsychotic that the LAI formulation is based on. Presentation matters for LAI treatments to be accepted by patients and family members. Clinicians can use certain communication tools to improve their dialogue with patients about the benefits of switching from oral agents.
在治疗精神分裂症时，必须尽早将短期和长期目标联系起来。维持治疗是预防复发的关键。复发是严重的事件，会改变疾病进程，并且通常与不遵医嘱有关。精神分裂症患者复发的风险很大，尤其是在他们不遵医嘱使用抗精神病药物时。由于复发伴随着结构脑变化、症状恶化和药物重新开始治疗时的耐药性增加，因此临床医生必须监测不遵医嘱情况，并提供策略来避免或改善这种情况。长效注射（LAI）抗精神病药物有可能降低不遵医嘱、复发、再住院和死亡率，即使是在首发精神分裂症和合并物质使用障碍的患者中也是如此。长效制剂可以成为一种非常有效的策略，有助于确保患者从他们所开的药物中获益，因为由于它们对患者的给药方式，长效制剂的使用比口服药物更容易监测。然而，开处方者往往认为患者对 LAI 有负面态度，避免开这种药。应向患者提供 LAI 抗精神病治疗的选择，并让他们了解治疗方案的后勤和潜在好处。LAI 在其起始策略、持续时间和注射间隔的灵活性方面存在差异，此外，它们所基于的抗精神病药物也存在差异。LAI 治疗的呈现方式对患者和家属接受治疗非常重要。临床医生可以使用某些沟通工具来改善与患者关于从口服药物转换的好处的对话。
