Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Schizophrenia | Research

Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study

Authors: Hsue-Wei Chan, Chin-Yu Huang, Yung-Chieh Yen

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Schizophrenia is a severe psychiatric disorder. Poor medical adherence increases relapse rate. Long-acting injection of antipsychotic agent is developed for improving medical adherence. In this study, we examined the effect of paliperidone long-acting injection (PLAI) treatment in patients with schizophrenia in a real-world setting.

Methods

In this retrospective cohort study, 467 patients with schizophrenia were enrolled, treated with risperidone PLAI or oral antipsychotics, and followed for 1 year. Concomitant medication, namely anticonvulsants, antidepressants, anxiolytics, sedatives or hypnotics, anticholinergics, and beta-blockers, were administered. Patients were classified into 2 groups: the LAI group (patients received LAI for treatment) and the NLAI group (patients taking only oral antipsychotics). The incidence of hospitalization, the length of hospitalization, and the incidence of emergency room visits were assessed.

Results

The LAI group had a higher incidence of psychiatric acute ward admission (NLAI group = 4.8%; LAI = 30.3%) and emergency room visits (NLAI group = 7.3%; LAI group = 36.0%) before enrolment. During the one-year follow-up, the incidence of acute ward admission and emergency room visit did not differ in the NLAI group (P = .586 and .241) compared with before enrolment, whereas both incidences were significantly decreased in the LAI group (P < .0001 in both of them).

Conclusions

PLAI reduces the incidence of admission and emergency room visits.

Stępnicki P, Kondej M, Kaczor AA. Current concepts and treatments of schizophrenia. Molecules. 2018;23(8):2087. https://doi.org/10.3390/molecules23082087.CrossRefPubMedCentral

Carbon M, Correll CU. Thinking and acting beyond the positive: the role of the cognitive and negative symptoms in schizophrenia. CNS Spectr. 2014;19(S1):35–53. https://doi.org/10.1017/S1092852914000601.CrossRef

Wójciak P, Rybakowski J. Clinical picture, pathogenesis and psychometric assessment of negative symptoms of schizophrenia. Psychiatr Pol. 2018;52(2):185–97. https://doi.org/10.12740/PP/70610.CrossRefPubMed

Rogers R, Gillis JR, Turner RE, Frise-Smith T. The clinical presentation of command hallucinations in a forensic population. Am J Psychiatry. 1990;147(10):1304–7.

Birchwood M, Chadwick P. The omnipotence of voices: testing the validity of a cognitive model. Psychol Med. 1997;27(6):1345–53. https://doi.org/10.1017/S0033291797005552.CrossRefPubMed

Ellett L, Luzon O, Birchwood M, Abbas Z, Harris A, Chadwick P. Distress, omnipotence, and responsibility beliefs in command hallucinations. Br J Clin Psychol. 2017;56(3):303–9. https://doi.org/10.1111/bjc.12139.CrossRefPubMed

Birchwood M, Michail M, Meaden A, Tarrier N, Lewis S, Wykes T, et al. Cognitive behaviour therapy to prevent harmful compliance with COMMAND hallucinations (COMMAND): a randomised controlled trial. Lancet Psychiatry. 2014;1(1):23–33. https://doi.org/10.1016/S2215-0366(14)70247-0.CrossRefPubMed

Luhrmann TM, Padmavati R, Tharoor H, Osei A. Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study. Br J Psychiatry. 2015;206(1):41–4. https://doi.org/10.1192/bjp.bp.113.139048.CrossRefPubMed

Dugré JR, West ML. Disentangling compliance with command hallucinations: heterogeneity of voice intents and their clinical correlates. Schizophr Res. 2019;212:33–9. https://doi.org/10.1016/j.schres.2019.08.016.CrossRefPubMed

10.

Chan B, Shehtman M. Clinical risk factors of acute severe or fatal violence among forensic mental health patients. Psychiatry Res. 2019;275:20–6. https://doi.org/10.1016/j.psychres.2019.03.005.CrossRefPubMed

11.

Barrowcliff AL, Haddock G. Factors affecting compliance and resistance to auditory command hallucinations: perceptions of a clinical population. J Ment Health. 2010;19(6):542–52. https://doi.org/10.3109/09638237.2010.520365.CrossRefPubMed

12.

Fox JR, Gray NS, Lewis H. Factors determining compliance with command hallucinations with violent content: the role of social rank, perceived power of the voice and voice malevolence. J Forensic Psychiatry Psychol. 2004;15(3):511–31. https://doi.org/10.1080/1478994042000226741.CrossRef

13.

Dugré JR, Guay JP, Dumais A. Risk factors of compliance with self-harm command hallucinations in individuals with affective and non-affective psychosis. Schizophr Res. 2018;195:115–21. https://doi.org/10.1016/j.schres.2017.09.001.CrossRefPubMed

14.

West ML. Clinical insights: addressing command hallucinations. Schizophr Res. 2018;197:63–4. https://doi.org/10.1016/j.schres.2017.11.004.CrossRefPubMed

15.

Imai A, Hayashi N, Shiina A, Sakikawa N, Igarashi Y. Factors associated with violence among Japanese patients with schizophrenia prior to psychiatric emergency hospitalization: a case-controlled study. Schizophr Res. 2014;160(1–3):27–32. https://doi.org/10.1016/j.schres.2014.10.016.CrossRefPubMed

16.

Moritz S, Schmidt SJ, Lüdtke T, Braunschneider LE, Manske A, Schneider BC, et al. Post-psychotic depression: paranoia and the damage done. Schizophr Res. 2019;211:79–85. https://doi.org/10.1016/j.schres.2019.06.022.CrossRefPubMed

17.

Freeman D, Bold E, Chadwick E, Taylor KM, Collett N, Diamond R, et al. Suicidal ideation and behaviour in patients with persecutory delusions: prevalence, symptom associations, and psychological correlates. Compr Psychiatry. 2019;93:41–7. https://doi.org/10.1016/j.comppsych.2019.07.001.CrossRefPubMed

18.

Darrell-Berry H, Berry K, Bucci S. The relationship between paranoia and aggression in psychosis: a systematic review. Schizophr Res. 2016;172(1–3):169–76. https://doi.org/10.1016/j.schres.2016.02.009.CrossRefPubMed

19.

Keers R, Ullrich S, DeStavola BL, Coid JW. Association of violence with emergence of persecutory delusions in untreated schizophrenia. Am J Psychiatr. 2014;171(3):332–9. https://doi.org/10.1176/appi.ajp.2013.13010134.CrossRefPubMed

20.

Serper MR. Aggression in schizophrenia. Schizophr Bull. 2011;37(5):897–8. https://doi.org/10.1093/schbul/sbr090.CrossRefPubMedPubMedCentral

21.

Andreasen NC. The scale for the assessment of negative symptoms (SANS): conceptual and theoretical foundations. Br J Psychiatry. 1989;155(S7):49–52. https://doi.org/10.1192/S0007125000291496.CrossRef

22.

Azorin JM, Belzeaux R, Adida M. Negative symptoms in schizophrenia: where we have been and where we are heading. CNS Neurosci Ther. 2014;20(9):801–8. https://doi.org/10.1111/cns.12292.CrossRefPubMedPubMedCentral

23.

Foussias G, Remington G. Negative symptoms in schizophrenia: avolition and Occam's razor. Schizophr Bull. 2010;36(2):359–69. https://doi.org/10.1093/schbul/sbn094.CrossRefPubMed

24.

Kahn RS, Sommer IE, Murray RM, et al. Schizophrenia. Nat Rev Dis Primers. 2015;1(1):15067. https://doi.org/10.1038/nrdp.2015.67.CrossRefPubMed

25.

Chen AT, Nasrallah HA. Neuroprotective effects of the second generation antipsychotics. Schizophr Res. 2019;208:1–7. https://doi.org/10.1016/j.schres.2019.04.009.CrossRefPubMed

26.

García-Cabeza I, Díaz-Caneja CM, Ovejero M, de Portugal E. Adherence, insight and disability in paranoid schizophrenia. Psychiatry Res. 2018;270:274–80. https://doi.org/10.1016/j.psychres.2018.09.021.CrossRefPubMed

27.

Bernardo M, Canas F, Herrera B, Dorado MG. Adherence predicts symptomatic and psychosocial remission in schizophrenia: naturalistic study of patient integration in the community. Rev Psiquiatr Salud Ment (English Edition). 2017;10(3):149–59. https://doi.org/10.1016/j.rpsmen.2017.05.008.CrossRef

28.

Lincoln TM, Lüllmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull. 2007;33(6):1324–42. https://doi.org/10.1093/schbul/sbm002.CrossRefPubMedPubMedCentral

29.

Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G. Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev Neurother. 2009;9(7):1035–43. https://doi.org/10.1586/ern.09.55.CrossRefPubMed

30.

Schennach R, Meyer S, Seemüller F, Jäger M, Schmauss M, Laux G, et al. Insight in schizophrenia–course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder. Eur Psychiatry. 2012;27(8):625–33. https://doi.org/10.1016/j.eurpsy.2012.01.001.CrossRefPubMed

31.

Lysaker PH, Vohs J, Hillis JD, Kukla M, Popolo R, Salvatore G, et al. Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother. 2013;13(7):785–93. https://doi.org/10.1586/14737175.2013.811150.CrossRefPubMed

32.

Jonsdottir H, Opjordsmoen S, Birkenaes AB, Simonsen C, Engh JA, Ringen PA, et al. Predictors of medication adherence in patients with schizophrenia and bipolar disorder. Acta Psychiatr Scand. 2013;127(1):23–33. https://doi.org/10.1111/j.1600-0447.2012.01911.x.CrossRefPubMed

33.

Remington G, Foussias G, Agid O, Fervaha G, Takeuchi H, Hahn M. The neurobiology of relapse in schizophrenia. Schizophr Res. 2014;152(2–3):381–90. https://doi.org/10.1016/j.schres.2013.10.009.CrossRefPubMed

34.

Coid JW, Ullrich S, Bebbington P, Fazel S, Keers R. Paranoid ideation and violence: meta-analysis of individual subject data of 7 population surveys. Schizophr Bull. 2016;42(4):907–15. https://doi.org/10.1093/schbul/sbw006.CrossRefPubMedPubMedCentral

35.

Mohr P, Galderisi S, Boyer P, Wasserman D, Arteel P, Ieven A, et al. Value of schizophrenia treatment I: the patient journey. Eur Psychiatry. 2018;53:107–15. https://doi.org/10.1016/j.eurpsy.2018.06.007.CrossRefPubMed

36.

Kovács G, Almási T, Millier A, Toumi M, Horváth M, Kóczián K, et al. Direct healthcare cost of schizophrenia–European overview. Eur Psychiatry. 2018;48(1):79–92. https://doi.org/10.1016/j.eurpsy.2017.10.008.CrossRefPubMed

37.

George A, Lakshmi V. The burden of schizophrenia on caregivers: a review. Pharmacoeconomics. 2008;26(2):149–62. https://doi.org/10.2165/00019053-200826020-00005.CrossRef

38.

Nordstroem AL, Talbot D, Bernasconi C, Berardo CG, Lalonde J. Burden of illness of people with persistent symptoms of schizophrenia: a multinational cross-sectional study. Int J Soc Psychiatry. 2017;63(2):139–50. https://doi.org/10.1177/0020764016688040.CrossRefPubMed

39.

Correll CU, Citrome L, Haddad PM, Lauriello J, Olfson M, Calloway SM, et al. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. J Clin Psychiatry. 2016;77(suppl 3):1–24. https://doi.org/10.4088/JCP.15032su1.CrossRefPubMed

40.

Buckley P, Citrome L, Nichita C, Vitacco M. Psychopharmacology of aggression in schizophrenia. Schizophr Bull. 2011;37(5):930–6. https://doi.org/10.1093/schbul/sbr104.CrossRefPubMedPubMedCentral

41.

Taipale H, Mittendorfer-Rutz E, Alexanderson K, Majak M, Mehtälä J, Hoti F, et al. Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia. Schizophr Res. 2018;197:274–80. https://doi.org/10.1016/j.schres.2017.12.010.CrossRefPubMed

42.

Misawa F, Kishimoto T, Hagi K, Kane JM, Correll CU. Safety and tolerability of long-acting injectable versus oral antipsychotics: a meta-analysis of randomized controlled studies comparing the same antipsychotics. Schizophr Res. 2016;176(2–3):220–30. https://doi.org/10.1016/j.schres.2016.07.018.CrossRefPubMed

43.

Nussbaum AM, Stroup TS. Paliperidone palmitate for schizophrenia. Schizophr Bull. 2012;38(6):1124–7. https://doi.org/10.1093/schbul/sbs099.CrossRefPubMedPubMedCentral

44.

Gopal S, Berwaerts J, Nuamah I, Akhras K, Coppola D, Daly E, et al. Number needed to treat and number needed to harm with paliperidone palmitate relative to long-acting haloperidol, bromperidol, and fluphenazine decanoate for treatment of patients with schizophrenia. Neuropsychiatr Dis Treat. 2011;7:93. https://doi.org/10.2147/NDT.S17177.CrossRefPubMedPubMedCentral

45.

Schreiner A, Aadamsoo K, Altamura AC, Franco M, Gorwood P, Neznanov NG, et al. Paliperidone palmitate versus oral antipsychotics in recently diagnosed schizophrenia. Schizophr Res. 2015;169(1–3):393–9. https://doi.org/10.1016/j.schres.2015.08.015.CrossRefPubMed

46.

Starr HL, Bermak J, Mao L, Rodriguez S, Alphs L. Comparison of long-acting and oral antipsychotic treatment effects in patients with schizophrenia, comorbid substance abuse, and a history of recent incarceration: an exploratory analysis of the PRIDE study. Schizophr Res. 2018;194:39–46. https://doi.org/10.1016/j.schres.2017.05.005.CrossRef

47.

Fu DJ, Turkoz I, Walling D, Lindenmayer JP, Schooler NR, Alphs L. Paliperidone palmitate once-monthly maintains improvement in functioning domains of the personal and social performance scale compared with placebo in subjects with schizoaffective disorder. Schizophr Res. 2018;192:185–93. https://doi.org/10.1016/j.schres.2017.04.004.CrossRefPubMed

48.

Bioque M, Parellada E, García-Rizo C, Amoretti S, Fortea A, Oriolo G, et al. Clozapine and paliperidone palmitate antipsychotic combination in treatment-resistant schizophrenia and other psychotic disorders: a retrospective 6-month mirror-image study. Eur Psychiatry. 2020;63(1):e71. https://doi.org/10.1192/j.eurpsy.2020.72.CrossRefPubMedPubMedCentral

49.

Fu DJ, Turkoz I, Simonson RB, Walling D, Schooler N, Lindenmayer JP, et al. Paliperidone palmitate once-monthly injectable treatment for acute exacerbations of schizoaffective disorder. J Clin Psychopharmacol. 2016;36(4):372–6. https://doi.org/10.1097/JCP.0000000000000535.CrossRefPubMedPubMedCentral

50.

Schreiner A, Bergmans P, Cherubin P, Hargarter L. The effect of long-acting paliperidone palmitate once-monthly on negative and depressive symptoms in patients with schizophrenia switched from previous unsuccessful treatment with oral aripiprazole. Ther Adv Psychopharmacol. 2017;7(2):59–65. https://doi.org/10.1177/2045125316673012.CrossRefPubMed

51.

Patel C, Emond B, Lafeuille MH, Côté-Sergent A, Lefebvre P, Tandon N, et al. Real-world analysis of switching patients with schizophrenia from Oral risperidone or Oral Paliperidone to once-monthly Paliperidone palmitate. Drugs-Real World Outcomes. 2020;7(1):19–29. https://doi.org/10.1007/s40801-019-00172-9.CrossRefPubMed

52.

Pappa S, Mason K. Partial compliance with long-acting paliperidone palmitate and impact on hospitalization: a 6-year mirror-image study. Ther Adv Psychopharmacol. 2020;10:2045125320924789. https://doi.org/10.1177/2045125320924789.CrossRefPubMedPubMedCentral

53.

Devrimci-Ozguven H, Atmaca M, Baran Z, Cengisiz C, Çinar C, Erol A, et al. Efficacy and safety of Paliperidone palmitate treatment in patients with schizophrenia: a real-world multicenter, retrospective, Mirror-image study. J Clin Psychopharmacol. 2019;39(6):604–10. https://doi.org/10.1097/JCP.0000000000001133.CrossRefPubMed

54.

Oh SY, Jon DI, Hong HJ, Hong N, Yi JS, Roh D, et al. The impact of paliperidone palmitate on hospitalization in patients with schizophrenia: a retrospective mirror-image study. Clin Psychopharmacol Neurosci. 2019;17(4):531–6. https://doi.org/10.9758/cpn.2019.17.4.531.CrossRefPubMedPubMedCentral

55.

Taipale H, Mehtälä J, Tanskanen A, Tiihonen J. Comparative effectiveness of antipsychotic drugs for Rehospitalization in schizophrenia-a Nationwide study with 20-year follow-up. Schizophr Bull. 2018;44(6):1381–7. https://doi.org/10.1093/schbul/sbx176.CrossRefPubMed

56.

Lee D, Lee BC, Choi SH, Kang DH, Jon DI, Jung MH. Effects of Paliperidone palmitate on healthcare utilization and costs for patients with schizophrenia: a claim-based Mirror-image study in South Korea. Clin Psychopharmacol Neurosci. 2020;18(2):303–10. https://doi.org/10.9758/cpn.2020.18.2.303.CrossRefPubMedPubMedCentral

Title: Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study
Authors: Hsue-Wei Chan
Chin-Yu Huang
Yung-Chieh Yen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Schizophrenia
Antipsychotics
Antipsychotics
Paliperidone
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03513-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Temporal and diurnal variation in social media posts to a suicide support forum

Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders

Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial

Hope level and associated factors among parents of retinoblastoma patients during COVID-19 pandemic: a cross-sectional study

Self-reported psychological problems and coping strategies: a web-based study in Peruvian population during COVID-19 pandemic

How do care providers evaluate collaboration? - qualitative process evaluation of a cluster-randomized controlled trial of collaborative and stepped care for patients with mental disorders