The challenge of offering long-acting antipsychotic therapies: a preliminary discourse analysis of psychiatrist recommendations for injectable therapy to patients with schizophrenia.
OBJECTIVE
To characterize patterns of communication in the offer of long-acting injectable (LAI) antipsychotic medication made by psychiatrists to patients with schizophrenia by (1) examining the style and content of their interaction and (2) determining how these may have driven the ultimate response to recommendations for LAI therapy.


METHODS
This was an observational study conducted at 10 community mental health centers in 3 waves from July 2010 to May 2011. The final dataset for discourse analysis was 33 recorded conversations in which a psychiatrist offered an injectable antipsychotic to a patient with schizophrenia. These visits were transcribed and analyzed by a team of linguists and social scientists.


RESULTS
Our primary finding is that, based on analyses of their language during the interview, psychiatrists presented LAI therapy in a negative light. Supporting this, 11 of 33 recommendations (33%) were accepted during the discussion, whereas in the postvisit interview, 27 of 28 patients (96%) who seemed to decline the initial recommendation said they actually would be willing to try LAI treatment.


CONCLUSIONS
These data support a preliminary hypothesis that the relatively low use of injectable antipsychotic therapies in the United States relative to other parts of the world is not fully attributable to patient rejection of the injectable modality. Rather, psychiatrists' ambivalence regarding the value of LAIs may play a significant role in the perceived difficulty with patient acceptance of this recommendation.
Department of Psychiatry, University of Illinois at Chicago, 912 South Wood St, Chicago, IL 60612 pjweiden@gmail.com.
Peter J
PJ
Weiden
Rebecca S
RS
Roma
Dawn I
DI
Velligan
Larry
L
Alphs
Matthew
M
DiChiara
Brad
B
Davidson
D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D010817:Physician-Patient Relations; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States; D014743:Videotape Recording
D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations