Spotlight on once-monthly long-acting injectable aripiprazole and its potential as maintenance treatment for bipolar I disorder in adult patients

Vanessa Torres-Llenza, Pooja Lakshmin, Daniel Z Lieberman Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA Abstract: The lack of long-term medication adherence is a challenge in the treatment of bipolar disorder, particularly during the maintenance phase when symptoms are less prominent. The rate of nonadherence is ~20%–60% depending on how strict a definition is used. Nonadherence worsens the course of bipolar disorder and can add hundreds of thousands of dollars to the lifetime cost of treating the illness. Long-acting injectable (LAI) medication is an attractive alternative to daily dosing of oral medication, especially among patients who are ambivalent about treatment. The purpose of this paper is to review the evidence for the safety and efficacy of LAI aripiprazole, which was recently approved for the treatment of bipolar disorder. The approval was based on a single double-blind, placebo-controlled, multisite trial that recruited participants from 103 sites in 7 countries. A total of 731 participants with bipolar disorder were enrolled in the study. Out of that total, 266 were successfully stabilized on LAI aripiprazole and entered the randomization phase. Treatment-emergent adverse events were, for the most part, mild to moderate. Akathisia was the most common adverse event, which, combined with restlessness, was experienced by 23% of the sample. At the end of the 52-week study period, nearly twice as many LAI-treated participants remained stable compared to those treated with placebo. Stability during the maintenance phase is arguably the most important goal of treatment. It is during this period of relative freedom from symptoms that patients are able to build a meaningful and satisfying life. The availability of a new treatment agent, particularly one that has the potential to enhance long-term adherence, is a welcome development. Keywords: antipsychotic, adherence, partial agonist, mood stabilizer, revie

Developing the Group Facilitation Assessment of Competencies Tool for Group-Based Mental Health and Psychosocial Support Interventions in Humanitarian and Low-Resource Settings

In humanitarian settings, mental health and psychosocial support services (MHPSS) are often delivered in group-based formats. Group interventions enable providers to reach more individuals when resources and technical expertise are limited. Group-based programs also foster social support, empathy, and collective problem-solving among the participants. To remedy the current lack of tools available to assess the group facilitation competencies of individuals delivering group-based MHPSS, we made it our objective to develop such a tool. Our approach, which focused on adults, complimented a similar initiative underway for children and adolescents. We reviewed MHPSS manuals to identify key group facilitation competencies, which include developing and reviewing group ground rules, facilitating participation among all group members, fostering empathy between members, encouraging collaborative problem-solving, addressing barriers to attendance, time management, and ensuring group confidentiality. We then developed the Group Facilitation Assessment of Competencies (GroupACT) Tool. The GroupACT is a structured observational tool for assessing these competencies during standardized role-plays with actor clients, or in vivo during the delivery of group sessions with actual clients. We conclude this article with guidance for using the GroupACT to assess facilitators’ competencies in providing group-based MHPSS in the health, education, protection, and other sectors in humanitarian settings