P.3.d.058
A 10 year follow-up study of long acting injectable risperidone use in severe mental disorders
Authors: A. Fernandez-Quintana1, M.C. García-Mahía2, M. Vidal-Millares2.
1Clinical University Hospital of La Coruña- Spain, La Coruña, Spain.
2Clinical University Hospital of La Coruña- Spain, Psychiatry, La Coruña, Spain.
Introduction:
The development of Long-Acting Injectable Risperidone (LAIR) represented a milestone in the treatment of Severe Mental Disorders by virtue of a favourable
atypical antipsychotic side-effect profile in combination with assured medication compliance [1]. LAIR has been proven efficacious, safe and well tolerated [2].
However, few follow-up studies have evaluated the clinical course and prognosis for patients receiving LAIR.
Aims:
The aim of this study is to investigate the long-term outcome for patients with Severe Mental Disorders receiving LAIR upon discharge from an Acute
Psychiatric Inpatient Unit and to analyse their overall prognosis according to diagnostic subgroups.
Methods:
A retrospective study was performed on a sample composed of 320 patients with a diagnosis of any psychotic disorder included in the Diagnostic Related
Group 430 (DRG 430): Schizophrenia, Affective Psychosis, Paranoid Disorders and other Functional Psychosis. The sample was recruited over a 10-year
period (January 2003-December 2013) and included all hospitalized patients in an Acute Psychiatric Inpatient Unit receiving LAIR upon discharge. Clinical
and socio-demographic variables were obtained from medical records. Clinical outcomes before LAIR prescription and after switching treatment to LAIR were
compared, including number of hospitalizations, length of stay (LOS), rates of drop-out from antipsychotic treatment, number of involuntary hospital
admissions, frequency of aggressive behaviour incidents and number of suicide attempts. Patients receiving treatment with Electroconvulsive Therapy (ECT)
were excluded from the study.
Results:
Diagnosis were distributed in the sample according to the following percentages: 47.5% Schizophrenia, 25.9% Bipolar Disorder, 16.8% Schizoaffective
disorder, 9.8% Other Functional Psychosis. Mean age was 29.5 years (SD: 9.21). The sample was composed of 67.1% men and 32.9% women. Mean duration
of psychotic illness was 7.2 years. Mean duration of treatment with LAIR was 3.31 years. No statistically significant differences were detected among patients
included in diagnostic subgroups in relation to age or sex. Patients with longer duration of LAIR treatment showed better medication compliance, lower rates of
relapse, lower hospitalization rates and shorter length of stay. These results were statistically significant (p<0.01). Criminal convictions, aggressive behaviour
incidents and suicide attempts were also less frequent among patients with longer duration of LAIR treatment. Mean duration of treatment maintenance with
LAIR was longer among the subgroup with Bipolar Disorder (7.92 years), followed (in decreasing order) by patients with a diagnosis of Schizophrenia,
Schizoaffective disorder and other psychosis (p<0.05). After LAI administration, patients were found to achieve longer inter-episodic maintenance of stability,
shorter lengths of stay (mean=14.3 days post-LAIR, mean=21 days pre-LAIR) and less crime-related hospital admissions (p<0.01).
Mean time (years) of LAIR treatment by
diagnostic group
Sample distribution by diagnosis
Clinical events related to LAIR duration of treatment
9
3,88
Mean of Hospital
Admissions
7,9
Other Functional
Psychosis
10%
Schizoaffective
Disorder
17%
8
4
7
3,1
Suicide Attempts
6
Schizophrenia
47%
6,8
5
> 2 years
< 2 years
2,1
4,1
Agressive Behaviour
4
9,2
3
19,4
Bipolar Disorder
26%
Mean of Relapses
2
24,1
1,18
1
0,4
78
Medication Compliance
0
Schizophrenia
Bipolar Disorder
Schizoaffective Disorder
Other Functional
Psychosis
69
0
10
20
30
40
50
60
70
80
90
Conclusions:
1. LAIR administration upon discharge from an Acute Psychiatric Inpatient Unit for patients with Severe Mental Disorders is associated with a significant
improvement in clinical variables such as lower rates of relapse, lower hospitalization frequency, shorter length of stay and better treatment compliance.
Therefore, LAIR improves the overall prognosis among these patients.
2.
Further studies are needed in order to confirm these findings given symptom severity or diagnostic categories could account for confounding factors.
References:
[1] Möller, H.J., 2007. Long-acting injectable risperidone for the treatment of schizophrenia: clinical perspectives. Drugs 67(11):1541-66.
[2] Keith, S., 2009. Use of long-acting risperidone in psychiatric disorders: focus on efficacy, safety and cost-effectiveness. Expert Rev Neurother 9(1):9-31.
There is no potential conflict of interest