Kai-Chun Yang1,2, Yin-To Liao3,4, Yen-Kuang Yang5,6,7, Shih-Ku Lin8,9,10, Chih-Sung Liang11,12, Ya-Mei Bai13,14,15. 1. Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Rd., Beitou, 11217, Taipei, Taiwan. 2. Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. 3. Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan. 4. Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 5. Department of Psychiatry, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan. 6. Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 7. Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan. 8. Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan. 9. Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan. 10. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 11. Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, No.60, Xinmin Road, Beitou District, Taipei, 11243, Taiwan. lcsyfw@gmail.com. 12. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan. lcsyfw@gmail.com. 13. Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Rd., Beitou, 11217, Taipei, Taiwan. ymbi@mail2000.com.tw. 14. Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. ymbi@mail2000.com.tw. 15. Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan. ymbi@mail2000.com.tw.
Abstract
OBJECTIVE: Schizophrenia is a chronic, debilitating psychiatric disorder with a high risk of relapse. Nonadherence to medication is a significant contributor to poor outcomes. Although long-acting injectable (LAI) antipsychotics prevent the relapse of schizophrenia, several factors present obstacles to the use of LAI antipsychotics, and clinical guidelines for LAI antipsychotics remain limited. To provide clinical recommendations, the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN) developed consensus statements for the effectiveness, target populations, initiation timing, and particular clinical situations for the use of LAI antipsychotics in patients with schizophrenia. METHODS: After a systematic literature review, a working group drafted consensus statements for the selected clinical topics and determined the levels of evidence-based recommendation based on the latest World Federation of Societies of Biological Psychiatry grading system. A scientific committee evaluated the draft statements and decided the final recommendations regarding the grades by anonymous voting after incorporating clinical experience and practice into the evidence from research. RESULTS: The TSBPN proposed ten consensus statements for the application of LAI antipsychotics. The current evidence supported that LAI antipsychotics could be a treatment option for all schizophrenia patients, including first-episode patients. LAI antipsychotics could be initiated both during an acute psychotic episode and when patients are stable. The consensus also gave recommendations for particular clinical situations with insufficient scientific data, such as for use in elderly or adolescent patients, patients with treatment-resistant schizophrenia, and breakthrough psychosis, and strategies to assist patients/caregivers with decision making. CONCLUSIONS: The consensus statements developed by the TSBPN provide evidence-based clinical recommendations and could give clinicians more confidence when prescribing LAI antipsychotics to treat schizophrenia, thereby improving treatment outcomes.
OBJECTIVE: Schizophrenia is a chronic, debilitating psychiatric disorder with a high risk of relapse. Nonadherence to medication is a significant contributor to poor outcomes. Although long-acting injectable (LAI) antipsychotics prevent the relapse of schizophrenia, several factors present obstacles to the use of LAI antipsychotics, and clinical guidelines for LAI antipsychotics remain limited. To provide clinical recommendations, the Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN) developed consensus statements for the effectiveness, target populations, initiation timing, and particular clinical situations for the use of LAI antipsychotics in patients with schizophrenia. METHODS: After a systematic literature review, a working group drafted consensus statements for the selected clinical topics and determined the levels of evidence-based recommendation based on the latest World Federation of Societies of Biological Psychiatry grading system. A scientific committee evaluated the draft statements and decided the final recommendations regarding the grades by anonymous voting after incorporating clinical experience and practice into the evidence from research. RESULTS: The TSBPN proposed ten consensus statements for the application of LAI antipsychotics. The current evidence supported that LAI antipsychotics could be a treatment option for all schizophrenia patients, including first-episode patients. LAI antipsychotics could be initiated both during an acute psychotic episode and when patients are stable. The consensus also gave recommendations for particular clinical situations with insufficient scientific data, such as for use in elderly or adolescent patients, patients with treatment-resistant schizophrenia, and breakthrough psychosis, and strategies to assist patients/caregivers with decision making. CONCLUSIONS: The consensus statements developed by the TSBPN provide evidence-based clinical recommendations and could give clinicians more confidence when prescribing LAI antipsychotics to treat schizophrenia, thereby improving treatment outcomes.
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