Titusville, NJ, May 27, 2009 A new instrument for improving patient understanding and acceptance of long-acting injectable antipsychotic therapy (LAT) has been published in the April edition of Psychiatry 2009.1 This novel, psychosocial approach encompasses Goal setting, Action planning, Initiating treatment, and Nurturing motivation (GAIN) through the use of a clinical discussion tool.
Nonadherence to oral antipsychotic medications is one of the most significant clinical challenges in psychiatry and behavioral medicine, with rates of nonadherence estimated to be as high as 50 and 75 percent in the first and second years of treatment.2,3 Despite evidence suggesting that continuous antipsychotic treatment is more effective than interrupted treatment, and the fact that LAT is strongly recommended in many cases4, the prescription of LAT remains low in the United States. GAIN was developed to assist physicians and other clinicians by providing them with an effective approach to engage patients in a discussion of the consideration of LAT and in overcoming any related barriers.
"Long acting injectable therapies have typically been reserved for the most difficult patients where nonadherence to medication has been identified as a primary obstacle, usually because of repeated relapses. Utilizing long-acting therapies administered by a healthcare professional more widely has an advantage over daily oral formulations in that healthcare professionals will know when their patients are not taking their medications before the consequences of nonadherence occur. Early intervention may well prevent relapse," said Nina R. Schooler, Ph.D. Professor of Psychiatry & Behavioral Sciences at State University of New York Downstate Medical Center. "However, it is often difficult for clinicians to discuss injectable medications with patients because of reluctance to take injections and stigma. With GAIN, we now have an effective tool to use in approaching a recommendation and have the possibility to help more patients with schizophrenia as we work together to control their symptoms."
Risperidone long-acting therapy (RLAT, or RISPERDAL CONSTA), for the treatment of symptoms of schizophrenia, is one of several long-acting injectable products available. RISPERDAL CONSTA is the only long-acting injectable form of a class of newer medicines known as atypical antipsychotics approved in the U.S. RISPERDAL CONSTA is a proven medicine with an innovative delivery system that allows it to be given every two weeks. RISPERDAL CONSTA can help reduce the symptoms that are part of schizophrenia. A number of new atypical antipsychotic LAT formulations are also expected to be available in the future, which provided further rationale for the development of GAIN.
The Schizophrenia Treatment Acceptance Response Trial (START), an initial application of the GAIN approach, evaluated acceptance of RLAT versus approach as usual. Clinicians who used GAIN found it easy to implement and almost all indicated that they would use this tool with their current and future patients.5 Rates of patient acceptance and adherence to treatment were high for both arms (and indistinguishable), which was attributed to the positive effects of more frequent contact between patients and treatment teams than is typical. Further evaluation of the efficacy of GAIN in other clinical settings is needed to understand the full utility of the tool.
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