Investigation of the effect of long acting intramuscular antipsychotic treatment on clinical variables and psychotropic drug use

Psychiatric disorders with psychotic symptoms are a group of disorders that can be seen in all segments of the society, affect the functionality of the person in every aspect, and have high mortality and morbidity. The main method in the treatment of these disorders is drug treatment. Good treatment adherence is the most important factor required for medication to work. Poor treatment compliance is closely associated with increased relapse rates and impaired functionality in individuals with psychosis. Long-acting antipsychotic injection treatment is considered quite a good option for patients with poor treatment compliance. The aim of this study was to evaluate the clinical course and oral treatment needs of patients on LAIs (long acting injection) who were followed up in the psychiatric outpatient clinic of Mersin University Hospital, to compare the clinical course and oral treatment needs of patients before and after they started using LAIs, and to make a comparison between patients who were still using LAIs and patients taking only oral antipsychotics. A total of 131 patients, including 66 patients on LAI and 65 patients on oral antipsychotics only were included in our study. Sociodemographic and clinical data form, Insight Assessment Scale (IAS), Morisky Drug Compliance Scale, UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale, Global Assessment of Functioning Scale (GAS), Clinical Global Impression-Severity and Side Effect Scale, Brief Psychiatric Rating Scale were administered to the participants. Patients who received LAI and their relatives were additionally given a treatment satisfaction scale. Routine blood tests (fasting blood glucose, liver function tests, triglycerides, total cholesterol, LDL cholesterol (low-density lipoprotein), HDL cholesterol (high-density lipoprotein) and prolactin hormone) values of all patients included in the study were utilized. Blood tests of patients receiving LAI before the initiation of LAI were also included in the study. Statistical analyses were performed using SPSS Statistics 25.0. The results of our study showed that the number of total oral antipsychotics, 2nd generation oral antipsychotics, mood stabilizing medicines and hospitalizations were lower in the group using LAI compared to the non- users. The incidence of treatment for hyperlipidemia and cardiovascular disease was lower in the group using LAIs. It was also found that clinical course and disease severity of the group using LAI before the initiation of LAI was worse than the group using only oral antipsychotics. Patients using LAI and their caregivers generally reported high satisfaction on the Treatment Satisfaction Scale, and satisfaction scores of caregivers were significantly higher than the patients. It was observed that the number of episodes and hospitalizations of the patients decreased after LAI use compared to period before the initiation of LAI and there was also a decrease in the use of first generation antipsychotics after the initiation of LAI treatment. Among the laboratory values, only triglyceride levels decreased significantly in LAI users. In patients with a history of treatment non-compliance and inadequate social support, choosing LAI is a very good option for treatment continuity. In this way, the burden of oral psychotropic drugs can be reduced and the course of the disease can be improved. Although many studies have been conducted on LAIs, there is still a need for long-term studies with large samples. Keywords: Long-acting antipsychotic, intramuscular antipsychotic, depot antipsychotic, clinical variables, psychotropic treatment