Long-acting antipsychotics: patient\u2019s features and prescribing attitudes in Italy. Findings from the cross-sectional phase of an observational, longitudinal, multicenter study.
Scientific background. Long-acting injectable antipsychotics (LAIs) are considered one of the most important tools for ensuring medication adherence in people with chronic psychosis. In recent times many authors promoted an earlier and broader use of LAIs, considering not only their efficacy in preventing non-adherence (and therefore relapses), but also their potential role in simplifying the daily medication routine, ultimately ameliorating patient\u2019s quality of life. On this background, this study aims at describing how this new perspective influenced prescribing pattern in Community Psychiatry Services, with a specific interest in comparing first- and second-generation antipsychotics. Methods. The STAR Network \u201cDepot\u201d Study is an observational, longitudinal, multicenter study involving 35 Italian Community Psychiatry Services. Adult patients initiating a new LAI were recruited over a 12-months period and assessed for relevant socio-demographic and clinical features (employing also validated rating scales) at baseline, after 6 and 12 months. Descriptive statistics and a stepped multivariate logistic model accounting for the inter-center variability were employed. Results. Only results from the recruitment (or cross-sectional) phase will be discussed here. Four-hundred-fifty-one patients, mostly males over their 30s, were recruited. Patients were heterogeneously distributed between higher and lower levels of education, social functioning, overall symptom profiles and medication adherence. Beside schizophrenia, also bipolar disorders, personality disorders and mental organic conditions were well represented. Paliperidone and aripiprazole were the most frequently prescribed medications. Analyses showed that, compared to first-generation LAIs, second-generation LAIs were more likely to be prescribed to younger, employed patients, with higher affective symptoms, a diagnosis different from schizophrenia or bipolar disorder, and fewer previous LAI prescriptions. Discussion. LAIs are prescribed to heterogeneous populations of patients, often even off-label. The advocated paradigm shift is under way in clinical practice, although it appears to be largely limited to second-generation LAIs
