title: Treatment Duration With Long-Acting Injectable Antipsychotics After In-hospital Initiation: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Long-acting injectable (LAI) antipsychotics are recommended especially for patients with multiple admissions and poor adherence. The empirical basis of this strategy is a matter of debate.
  
  
  METHODS
  In a retrospective cohort study extending over 6 years, all patients admitted for inpatient treatment with a diagnosis of psychotic disorders according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (F2) were screened for treatment episodes with a new start of an LAI. Indication for LAI treatment was based primarily on previous medication default. All-cause discontinuation was used as a measure of treatment efficiency. Patients with early dropout (termination of LAI treatment within 6 months) were compared with patients with longer treatment (treatment >6 months) for sociodemographic and treatment variables using bivariate and multivariate analyses.
  
  
  RESULTS
  A total of 194 treatment episodes with new start of LAIs were identified. Almost one half dropped out within 6 months (early dropout: n = 95 [49%]; mean duration, 2.2 months). Termination of treatment was mainly due to patients' refusal to continue. However, almost a third of patients (61; 31.4%) had a treatment duration of more than 2 years. In a multivariate Cox regression model, longer treatment duration was associated with older age (P = 0.05), not being single (P = 0.04), fewer admissions during the year preceding the index episode (P = 0.02), and better ratings for adherence at the index episode (P = 0.03).
  
  
  CONCLUSIONS
  There are both more patients than expected leaving the treatment early and more patients than expected staying for long periods, even among patients with a history of poor adherence.
authors.affiliation: From the *Department of Psychiatry 1, Kepler University Hospital, Linz; †Department of Psychiatry, General Hospital Steyr, Steyr; and ‡Institute of Applied Statistics, Johannes-Kepler University, Linz, Austria.
authors.forename: Hans
authors.initials: H
authors.lastname: Rittmannsberger
authors.forename: Jan
authors.initials: J
authors.lastname: Rosenleitner
authors.forename: Gertraud
authors.initials: G
authors.lastname: Malsiner-Walli
authors.forename: Regina
authors.initials: R
authors.lastname: Werl
authors.forename: Barbara
authors.initials: B
authors.lastname: Rittmannsberger
authors.forename: Kurosch
authors.initials: K
authors.lastname: Yazdi
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D003692:Delayed-Action Preparations; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations