Keevia Porter, DNP, NP-C, RN
Purpose/Background Psychosis is a psychiatric disorder characterized by hallucinations and delusions. These symptoms not only negatively impact a patient’s quality of life but can also make treatment compliance difficult. This lack of treatment compliance ultimately leads to higher relapse and re-hospitalization rates among this population. Thus, it is imperative that effective treatments are developed, utilized, and made readily available for patients. Antipsychotics are medications that block dopamine D2 receptors. These medications are used for psychosis to help to improve patient outcomes. Currently, two routes of antipsychotic administration are available, oral antipsychotics or long-acting antipsychotic injections (LAIs). Oral antipsychotic administration requires daily dosing to achieve optimal plasma concentrations, whereas LAIs may be given every 2-12 weeks (NAMI, 2016). This scoping review aims to review the literature and compare the compliance, relapse, and re-hospitalization rates of patients prescribed LAIs versus patients prescribed oral antipsychotics. The purpose of this scoping review is to determine if LAIs result in better compliance and lower relapse and re-hospitalization when compared to oral antipsychotics. This knowledge can help providers make an individualized, evidence-based decision when developing a treatment plan for patients who have psychosis.
Methods The selected studies had to meet the following criteria: be written in English, all its participants were at least eighteen years old and gave their consent in writing, they had diagnoses of schizophrenia, delusional disorder, bipolar disorder, or schizoaffective disorder, and that the studies focused on long-acting antipsychotic injectables and oral antipsychotics. In this study, an extensive literature review of peer-reviewed studies on oral antipsychotics versus long-acting injectables was performed from PubMed, JAMA, Cochrane library, and CINHAL databases, these sites were also used to obtain information on LAIs and oral antipsychotics within psychosis and psychosis-related disorders such as schizophrenia, schizoaffective disorder, delusional disorder, and bipolar disorder with psychotic features. In addition, other reputable websites, such as the National Alliance on Mental Health were utilized for statistics information. The studies taken as evidence had a recent publication date, high quality, and reliability. Data charting included essential information regarding the sources of data, such as participant demographics, diagnosis, medication type, and other variables such as discharge date, compliance rate, relapse rate, re-hospitalization rate, and length of re-hospitalization stay. All studies were grouped by diagnosis and medication type. Further compliance, relapse, and re-hospitalization rates were summarized, and the synthesis of results provided evidence to answer the study questions and to identify patterns.
Results Ten research articles were determined to meet the criteria for this scoping review. No significant differences were determined between long-acting and oral antipsychotic compliance, relapse, and re-hospitalization rates. Behavioral therapy intervention and minimal side effect profiles decrease the relapse and compliance rates (Sajatovic et al., 2017; Kashimoto et al., 2014). Missed doses decreased from 57.7% to 22%, while attitudes regarding both medication and treatment increased when behavioral therapy was utilized. After the behavioral therapy intervention, a 92.9% adherence rate was found in long-acting antipsychotic participants (Sajatovic et al., 2017). Though no significant difference existed between oral and long-acting injectable antipsychotics, specific guidelines to target barriers to adherence could be addressed. Behavioral therapy and increased education help patients feel empowered and autonomous in their treatment decisions.
Implications for Nursing Practice Benefits would come from further research to determine differences between LAIs and oral antipsychotics regarding compliance, relapse, and re-hospitalization rates. In addition, behavioral therapy and increased education should be implemented when prescribing either an oral or long-acting injectable antipsychotic to a patient experiencing psychosis to increase patient attitudes, empowerment and autonomy in their treatment can increase chances of compliance.
Boyland, Latoria BSN, RN; Darretta, Kara BSN, RN; Geno, Ansley BSN, RN; and Porter, Keevia DNP, NP-C, RN , "Long-Acting Antipsychotic Injectables vs. Oral Antipsychotics: Comparing Compliance, Relapse, and Re-Hospitalization Rates" (2022). Doctor of Nursing Practice Projects. Paper 37. http://dx.doi.org/10.21007/con.dnp.2022.0037.
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