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European Psychiatry
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Original article
Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H,
50134 Florence, Italy
Department of biomedical and neuromotor sciences, university of Bologna, Bologna, Italy
c
Department of mental health and substance abuse, local health trust of Bologna, Bologna, Italy
d
Therapeutic psychiatric community, Campo del Vescovo Union, La Spezia, Italy
b
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 12 January 2016
Received in revised form 5 April 2016
Accepted 13 May 2016
Available online
Background: To present real-world evidence on the differences between long-acting injectable (LAI) and
oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards
drug and quality of life in a sample of remitted schizophrenic subjects.
Methods: Twenty outpatients with remitted schizophrenia treated with either olanzapine or
paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were
recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral
AMT and matching main sociodemographic, clinical and treatment variables made up the control group
(oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and
subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1).
Results: Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K
dimensions (except for social integration), showed signicantly higher percentages of improvement in
the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality
of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after
the 6-month period. In contrast, the oral-AMT group reported a signicant worsening of health-related
quality of life in the areas of emotional role and social functioning in the same period.
Conclusions: Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms
of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration
of this study need to be expanded in order to produce more solid and generalizable results.
2016 Elsevier Masson SAS. All rights reserved.
Keywords:
Schizophrenia and psychosis
Antipsychotics
Quality of life
Quality of care
1. Introduction
Relapse and rehospitalisation lead to proven negative consequences in terms of course, treatment, prognosis and impact on the
healthcare system of schizophrenia [1,2]. For this reason, clinical
remission and relapse prevention are considered main goals in the
long-term management of this condition [3] and antipsychotic
maintenance treatment (AMT) is recommended to minimize the
relapse and readmission risk [4,5].
Unfortunately, adherence to antipsychotic treatment is often
compromised in schizophrenia [1,2]. The problem of poor
* Corresponding author. Tel.: +39 055 794 7487; fax: +39 055 794 7531.
E-mail address: francesco.pietrini@uni.it (F. Pietrini).
http://dx.doi.org/10.1016/j.eurpsy.2016.05.008
0924-9338/ 2016 Elsevier Masson SAS. All rights reserved.
36
37
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Table 1
Baseline characteristics of the sample.
Characteristic
Sociodemographic variables
Gender (M)
Age (years)
Education (years)
Marital status (single)
Clinical history
Illness duration (years)
Episodes of illness
Hospitalizations
Number of different antipsychotics received in the past
Psychopathology
PANSS
General
Positive
Negative
YMRS
MDRS
Antipsychotic treatment
Olanzapine
10 mg/day or 300 mg/month
Olanzapine
15 mg/day or 405 mg/month
Paliperidone
9 mg/day or 100 mg/month
Paliperidone
12 mg/day or 150 mg/month
Adherence to treatment
DAI-10
Concomitant treatments
None
Antidepressants
Mood stabilizers
Anxiolytics
Concomitant treatment for adverse effects of antipsychotics
AMT
x2
LAI
n = 20
Oral
n = 20
7 (35.0)
40.55 11.00
12.20 3.42
12 (60.0)
7 (35.0)
45.10 10.68
11.60 4.40
12 (60.0)
0.000
0.000
1.327
0.481
1.000
0.192
0.633
1.000
20.20 10.08
3.70 1.45
2.80 1.00
2.70 1.12
21.85 12.83
3.50 1.70
2.80 1.76
3.10 1.25
0.452
0.400
0.000
1.061
0.654
0.692
1.000
0.295
46.65 8.98
26.90 6.33
10.80 4.07
8.95 2.93
4.75 4.13
6.10 2.43
45.70 8.00
26.55 4.98
9.20 1.99
9.90 3.59
3.65 3.03
6.61 2.35
0.353
0.194
1.579
0.916
0.961
0.662
0.726
0.847
0.126
0.365
0.343
0.512
4 (20.0)
4 (20.0)
0.000
1.000
11 (55.0)
11 (55.0)
0.000
1.000
2 (10.0)
2 (10.0)
0.000
1.000
3 (15.0)
3 (15.0)
0.000
1.000
3.10 4.61
4.75 3.85
1.228
0.227
8
8
7
0
0
6
8
9
1
0
0.440
0.000
0.417
1.026
0.000
0.507
1.000
0.519
0.311
1.000
(40.0)
(40.0)
(35.0)
(0.0)
(0.0)
(30.0)
(40.0)
(45.0)
(5.0)
(0.0)
Statistics: discrete variables are reported as number (within-group percentage); Continuous variables are reported as mean standard deviation. AMT: antipsychotic
maintenance treatment; LAI: long-acting injectable; N: number; M: male; single: single or not in a stable relationship; PANSS: Positive and negative syndrome scale total score;
general: general psychopathology subscale of the PANSS; positive: positive subscale of the PANSS; negative: negative subscale of the PANSS; YMRS: Young mania rating scale;
MDRS: Montgomery-Asberg depression rating scale; DAI-10: drug attitude inventory short version.
39
Nonetheless, we observed an appreciable symptomatic improvement of the LAI-AMT group 6 months after the switch to the LAI
regimen, with no signicant treatment-associated side effects or
adverse events (Fig. 1). These results are consistent with previous
reports indicating the switch from oral to LAI antipsychotic
treatment as a safe and effective intervention in clinically stable
schizophrenic patients [14,19,21,22,46]. It is noteworthy that the
small but generalized improvement in psychometric scores
(between 0.56% and 6.19%) of the LAI-AMT group between T0
and T1 is particularly valuable in clinical practice, since it may
suggest the switch to LAI-AMT as a possible optimization strategy
for schizophrenic patients who already achieved clinical remission
with oral antipsychotics [18,23,24,27,28].
Differently from the LAI-AMT group, the oral-AMT group only
showed non-signicant changes in psychopathology during the
study period. When compared to this group, the LAI-AMT group
showed additional recovery in the general aspects of the
schizophrenic syndrome (PANSS general psychopathology subscale) (Fig. 1). Interestingly enough, among clinical features
evaluated by the PANSS, those addressed by the general
psychopathology subscale seem to be the most inuenced by
subjective treatment-related factors, such as subjective side
effects and attitudes towards drug (i.e. somatic concern,
40
Fig. 2. Changes in subjective experience of treatment after 6 months of antipsychotic maintenance treatment.
Fig. 3. Health-related quality of life at baseline and after 6 months of antipsychotic maintenance treatment.
41
42
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