title: Rethinking the role of long-acting atypical antipsychotics in the community setting.
abstract: Schizophrenia is a relapsing and evolving condition, which requires treatment continuity. Increasing evidence shows that antipsychotic discontinuation is associated with relapse in most patients, and that early interventions have a positive impact on long-term outcomes. Poor adherence to antipsychotics is a major factor in the treatment of schizophrenia and a relevant risk factor for relapse. Considerable effort has been made toward improving adherence, including the development of long-acting injectable (LAI) antipsychotics. LAIs have traditionally been reserved for patients with repeated nonadherence; currently, several misconceptions prevent their more widespread use. The recent introduction of LAI formulations of atypical antipsychotics and the encouraging results in terms of the reduction in relapse rates and avoidance of hospitalization warrant a reassessment of the role of LAIs in the management of schizophrenia. This paper presents the position of a panel of nine Italian schizophrenia experts on the use of novel LAI medications, with a focus on community-based services, the prevailing setting of schizophrenia treatment in Italy. The need to change the attitude toward LAIs--no longer a treatment of last resort, but a component of multimodal strategies leading patients to remission and rehabilitation--is emphasized. The paper also presents recommendations for LAI atypical antipsychotic use in the community setting.
authors.affiliation: Department of Mental Health, Psychiatry Clinic, University of Milan, Italy. carlo.altamura@unimi.it
authors.forename: Alfredo Carlo
authors.initials: AC
authors.lastname: Altamura
authors.forename: Eugenio
authors.initials: E
authors.lastname: Aguglia
authors.forename: Mariano
authors.initials: M
authors.lastname: Bassi
authors.forename: Filippo
authors.initials: F
authors.lastname: Bogetto
authors.forename: Lodovico
authors.initials: L
authors.lastname: Cappellari
authors.forename: Serafino
authors.initials: S
authors.lastname: De Giorgi
authors.forename: Andrea
authors.initials: A
authors.lastname: Fagiolini
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrannini
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000379:methods* / Q000639:trends; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D019317:Evidence-Based Medicine / Q000639:trends; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations