title: A Systemic Review and Experts' Consensus for Long-acting Injectable Antipsychotics in Bipolar Disorder.
abstract: Bipolar disorder (BD) is a major psychiatric disorder that is easily misdiagnosed. Patient adherence to a treatment regimen is of utmost importance for successful outcomes in BD. Several trials of antipsychotics suggested that depot antipsychotics, including long-acting first- and second-generation agents, are effective in preventing non-adherence, partial adherence, and in reducing relapse in BD. Various long-acting injectable (LAI) antipsychotics are available, including fluphenazine decanoate, haloperidol decanoate, olanzapine pamoate, risperidone microspheres, paliperidone palmitate, and aripiprazole monohydrate. Due to the increasing number of BD patients receiving LAI antipsychotics, treatment guidelines have been developed. However, the clinical applicability of LAI antipsychotics remains a global cause for concern, particularly in Asian countries. Expert physicians from Taiwan participated in a consensus meeting, which was held to review key areas based on both current literature and clinical practice. The purpose of this meeting was to generate a practical and implementable set of recommendations for LAI antipsychotic use to treat BD; target patient groups, dosage, administration, and adverse effects were considered. Experts recommended using LAI antipsychotics in patients with schizophrenia, rapid cycling BD, BD I, and bipolar-type schizoaffective disorder. LAI antipsychotic use was recommended in BD patients with the following characteristics: multiple episodes and low adherence; seldom yet serious episodes; low adherence potential per a physician's clinical judgment; preference for injectable agents over oral agents; and multiple oral agent users still experiencing residual symptoms.
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital & National Yang Ming University, Taipei, Taiwan.
authors.forename: Yuan Hwa
authors.initials: YH
authors.lastname: Chou
authors.affiliation: Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Po-Chung
authors.initials: PC
authors.lastname: Chu
authors.affiliation: Department of Psychiatry, Wei-Gong Memorial Hospital, Miaoli, Taiwan.
authors.forename: Szu-Wei
authors.initials: SW
authors.lastname: Wu
authors.affiliation: Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.
authors.forename: Jen-Chin
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Tainan Municipal Hospital, Tainan, Taiwan.
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Sun
authors.affiliation: Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Chen-Lin
authors.initials: CL
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Huang
authors.affiliation: Department of Psychiatry, Cardinal Tien Hospital, Taipei, Taiwan.
authors.forename: I-Chao
authors.initials: IC
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taiwan.
authors.forename: Chia-Fen
authors.initials: CF
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, E-Da Hospital, Kaohsiung, Taiwan.
authors.forename: Yung-Chieh
authors.initials: YC
authors.lastname: Yen
keywords: Bipolar disorder; Consensus; Long-acting injectable antipsychotics; Risperidone