[Compliance of long-acting atypical antipsychotics: from an image problem to a question of indication].
This paper focuses on the questions asked to practitioners regarding compliance to new long-acting atypical antipsychotics (LAAA): how does the comprehensive approach of patients' and carers' attitudes facing treatment challenge it?


OBJECTIVE
A review of recent literature shows that LAAA, are still suffering from an "image problem". We aim to describe these negative beliefs and suggest that LAAA indications be reconsidered.


METHODS
Following a comprehensive approach, we interpreted our review on the basis of anthropological criteria. We focused on value-based health and disease models that organize the attitude of patients and carers regarding the depot injection.


RESULTS
Multiple negative beliefs attached to the pain, side-effects, and stigmas are well-known to impair adhesion to treatment. Carers understand disease as a lack of insight. Patients experience it as a threat for the Self and a loss of autonomy. The nurse-patient relationship involving injections is an important factor of compliance. When time is devoted by the carer to paying attention to the patient's experience, in order to perceive the patient as a participant, patients are more likely to adopt the injectable route themselves. By doing so, the patient considers the injection as a "protective net" a "lesser evil" by integrating it within his(her) biography.


CONCLUSIONS
A comprehensive approach links the lack of insight to the patient's perception of stigma. Hope for recovery is related by the person him(her)self to his(her) own ability for autonomy. Persons with schizophrenia usually struggle for norms (agonomia). This trend has to be taken into account. LAAA are better indicated when patients are compliant. There is no indication when patients are "pure agonomics" and fight to deny both stigma and medication.
Naudin
J
J
SOLARIS, pôle universitaire de psychiatrie, CHU Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13274 Marseille cedex 09, France. jean.naudin@mail.ap-hm.fr
Dassa
D
D
Cermolacce
M
M
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001294:Attitude to Health; D001364:Awareness; D017028:Caregivers / Q000523:psychology; D003692:Delayed-Action Preparations; D006801:Humans; D007273:Injections, Intramuscular; D055118:Medication Adherence / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology; D011287:Prejudice; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations