[Rationale for the use of long-acting injectable risperidone: a survey of French psychiatrists].
L'Encéphale. 2013-05-01; 39: S8-S14
DOI: 10.1016/j.encep.2012.03.005
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1. Encephale. 2013 May;39 Suppl 1:S8-14. doi: 10.1016/j.encep.2012.03.005. Epub
2013 Mar 28.
[Rationale for the use of long-acting injectable risperidone: a survey of French
psychiatrists].
[Article in French]
Misdrahi D(1), Delgado A, Bouju S, Comet D, Chiariny JF.
Author information:
(1)Pôle 347 de psychiatrie adulte, hôpital Charles-Perrens, 121, rue de la
Béchade, 33076 Bordeaux cedex, France.
INTRODUCTION: Poor adherence is a major concern for the effectiveness of
antipsychotic treatment in patients with schizophrenia. In particular,
compliance problems constitute a poor prognostic factor for this disorder due to
increasing risk of relapse and hospitalization. As maintaining antipsychotic
therapy is a key element to prevent relapse, the use of depot preparations is
therefore considered as a useful therapeutic option since it prevents covert
non-adherence. When compared with neuroleptics, novel antipsychotic agents are
also better tolerated by patients. In this study, the rationale for the use of
long-acting injectable risperidone combining the benefits of novel antipsychotic
agent and depot preparation is investigated in patients with psychosis. A
secondary objective of the study is to assess the level of therapeutic adherence
and to confirm the role of its key determinants.
METHODS: An observational survey assessed the time and reasons to switch to
long-acting risperidone in 1887 hospitalized and community-dwelling patients
with psychosis (61.6% schizophrenia) defined by the CIM-10, and treated by 399
psychiatrists with oral risperidone for a recent acute episode. In a
cross-sectional study performed under real-life conditions, treatment adherence
was assessed by patients themselves using the Medication Adherence Questionnaire
(MAQ) and therapeutic alliance was assessed by the 4-Point Alliance Scale
(4-PAS). Psychiatrists assessed treatment acceptance using the Compliance Rating
Scale (CRS), disease severity using the CGI, and insight using the G12 item from
the Positive and Negative Syndrome Scale (PANSS).
RESULTS: In the population studied, disorder severity (CGI) was defined as
“moderate to marked” in 67.7% and “severe or among the most severe” for 21.1%.
Insight (PANSS G12) was defined as normal for 36.6% of patients, moderate for
34.8% and low for 28.6%. The mean time to medication switch was 8 weeks after
the start of care of the acute episode. The two main reasons to start the
long-acting injectable risperidone were related to non-compliance with oral
antipsychotic treatment (92.4%) and intention to improve efficacy (86.4%).
Maintenance of a good therapeutic alliance (70.3%) and treatment tolerability
(54.6%) were also often cited. For psychiatrists, 41.6% of patients demonstrated
reticence or active reluctance to treatment. Therapeutic compliance (MAQ) for
oral medication before the long-acting injectable risperidone was started was
estimated as “mild” for 53.1% (n=852) of patients. Poor adherence strongly
correlated with low insight (P