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Long-Acting Injection for Psychotic Disorder

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Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches

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Abstract

We present the case of a patient (27 years old) with a diagnosis of psychotic disorder who started a long-acting therapy after unsuccessful antipsychotic oral treatment. After the first admission, he was treated with haloperidol, but a few months later, he discontinued therapies due to extrapyramidal side effects. A new hospitalization was necessary for reacutization of his psychotic symptoms characterized by severe incongruous laughter, agitation, hostility, and delusions of persecution. In the psychiatric unit, olanzapine was started. By the second day, his psychotic presentation cleared with exception of mild residual perplexity and social isolation. By the fourth day of olanzapine treatment, patient agreed to start long-acting injectable olanzapine with the goal to eventually discontinue the oral olanzapine to provide a safeguard for nonadherence, and he was successfully discharged home.

In the presented case, we modified the dosage and the frequency of the injections on the basis of clinical picture, adapting the long-acting therapy to patient’s symptomatology with a good clinical response. Given the complex nature of symptoms presentation and medication regimens, some patients may benefit from personalized treatments. The new long-acting injectable options provide additional flexibility in terms of increasing the time interval between injections.

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Author information

Authors and Affiliations

  1. Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico, University of Milan, Milan, Italy

    M. C. Mauri & C. Di Pace

Authors
  1. M. C. Mauri
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  2. C. Di Pace
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Corresponding author

Correspondence to M. C. Mauri .

Editor information

Editors and Affiliations

  1. Department of Neuroscience and Mental Health, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alfredo Carlo Altamura

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, IRCCS “E. Medea” Scientific Institute, Bosisio Parini (Lc), Italy

    Paolo Brambilla

Self-Assessment Questionnaire

Self-Assessment Questionnaire

  1. 1.

    Who should receive LAIs?

    1. (A)

      Consider LAIs for patients with recent-onset schizophrenia and those with risk factors for medication nonadherence

    2. (B)

      Patients with poor insight

    3. (C)

      Patients with severe symptoms

    4. (D)

      Only patients with chronic schizophrenia

  2. 2.

    Are the newer LAIs more effective than the older LAIs in terms of prevention of relapses?

    1. (A)

      The effectiveness of newer LAIs (aripiprazole, olanzapine, paliperidone, and risperidone) and older LAIs (haloperidol, fluphenazine, flupenthixol) is similar.

    2. (B)

      The newer LAIs are more effective

    3. (C)

      The older LAIs are more effective

    4. (D)

      Aripiprazole LAI is less effective

  3. 3.

    Which of the following statements is true?

    1. (A)

      Any patient for whom long-term antipsychotic treatment is indicated should be considered for depot drugs

    2. (B)

      The presence of hallucinations is necessary for receiving long-acting therapy

    3. (C)

      Risperidone long acting has a small risk of postinjection sedation syndrome

    4. (D)

      Olanzapine long acting must overlap with oral supplementation

  4. 4.

    The factors influencing the choice not to prescribe a LAI for first-episode psychosis were:

    1. (A)

      Limited availability of different second-generation long-acting antipsychotics

    2. (B)

      Rejection of the depot by patient’s family

    3. (C)

      The inexperience of the clinicians with long-acting treatment

    4. (D)

      The necessity to receive depot by a health-care professional in a community setting

  5. 5.

    Which of the following antipsychotic medications does not come in a long-acting injectable formulation?

    1. (A)

      Risperidone

    2. (B)

      Olanzapine

    3. (C)

      Haloperidol

    4. (D)

      Quetiapine

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Mauri, M.C., Di Pace, C. (2019). Long-Acting Injection for Psychotic Disorder. In: Altamura, A., Brambilla, P. (eds) Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches. Springer, Cham. https://doi.org/10.1007/978-3-319-91557-9_14

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  • DOI: https://doi.org/10.1007/978-3-319-91557-9_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91556-2

  • Online ISBN: 978-3-319-91557-9

  • eBook Packages: MedicineMedicine (R0)

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