Long-acting injections, (LAI's), antipsychotics (AP's) are often regarded with some negativity because of the assumption of punishment, control, and insufficient evolution towards the psychosocial development of patients. However, LAI APs have proven to be effective in the treatment of schizophrenia and other severe psychotic disorders because they assure stable blood levels, leading to a reduction of the risk of relapse. Therapeutic opportunities have also arisen after the introduction of newer, second-generation LAI APs in recent years. Newer LAI APs are more readily dosed optimally, may be better tolerated, and are better suited to integrated rehabilitation programs. The older and newer LAI Aps are available for the treatment of schizophrenia, with considerations of past and present pharmacological and therapeutic issues. Traditional, evidence-based approaches to systematic reviews and randomized clinical trials are of limited utility in this area where observational research is particularly appropriate and effective. ( DeRisio,2016). Soon after the introduction of antipsychotics (APs) in the 1950s, poor adherence to oral formulations was found to be a critical issue. This led to the development in 1966 of the first long-acting injectable (LAI) AP fluphenazine enanthate, and fluphenazine decanoate some 18 months later, to reduce the incidence of side effects of the former medications. Haloperidol decanoate became available in Europe in 1981 and in the USA in 1986. Clinical trial results showed a dramatic reduction in the morbidity of schizophrenia. However, the concept of LAIs for schizophrenia was not initially received warmly by the medical profession for fears of increased side effects, lack of efficacy, and the fact this was seen as an attempt by psychiatrists to impose a treatment upon patients without due regard to their feelings or rights as well as the potential for medicolegal problems. However, with subsequent surveys and trials suggesting their benefits, LAIs became more widely adopted. ( Agid,2016). The introduction of the oral second-generation APs (SGAs) brought claims of better tolerance and less severe side effects, even though their use may be hindered by metabolic syndrome. They also have the potential to prevent or reverse accelerated frontotemporal cortical grey matter decline, and to provide a greater degree of neuroprotection than first generation APs (FGAs). The introduction of SGAs led to a decline in the use of LAI FGAs. However, it soon became clear that atypical characteristics did not bring better adherence rates with oral SGAs. The recent introduction of LAI SGAs allows psychiatrists once again to prescribe LAIs without losing any of the potential advantages of the SGAs by using this form of delivery. (DeRisio,2016). LAI APs offer a number of advantages compared with oral medication, including not having to remember to take drugs daily, reducing the risk of unintentional or deliberate overdose, and transparency of adherence, allowing healthcare professionals to be alerted and to intervene appropriately if patients fail to take their medication. When patients stop medication, plasma levels decrease more slowly than with oral formulations, giving time for the healthcare professionals to intervene at an early stage and lowering the probability of rebound symptoms or of a relapse occurring as rapidly. Moreover, if a patient suffers a relapse, despite receiving regular LAI treatment, it is then clear that compliance is not the reason. Other benefits include more consistent bioavailability and the more predictable correlation between dosage and plasma levels reduced peak-trough plasma levels, improved patient outcomes, improved patient and physician satisfaction, lower relapse rates than oral therapy, and more regular contact with the mental healthcare team. ( DeRisio,2016). The main disadvantage of LAIs relates to the slow dose titration and the long time required to achieve steady state levels. This disadvantage is most evident in acutely ill individuals, in whom there would be a need for rapid dose titration within days of initiating treatment. In addition, during this time oral AP supplementation may be necessary, adding to the complexity of the titration process. It is also more difficult to make sensible dose adjustments because the attainment of steady state plasma levels may take more than 2 months after a dose change. For these reasons, the initiation of LAIs has generally been confined to those periods when a patient is at least partially stabilized on their existing treatment. With some newer LAIs, such as paliperidone palmitate, rapid therapeutic levels can be attained by means of a 'loading dose regimen', allowing for its use in patients with moderate symptoms, and bringing about a rapid onset of action with no need for oral supplementation. ( Agid,2016). There is a need to increase the availability of additional LAI SGAs and to develop more reliable methods of AP delivery. Given the failure of the long-term oral treatments and bearing in mind that relapse can lead to serious consequences from all perspectives (biological and psychosocial), the future of schizophrenia pharmacotherapy will hopefully evolve to include better long-term delivery systems to more effectively address the high risk of relapse due to non-adherence in all phases of the illness. These should include not only longer extended release injectable formulations, but also intranasal formulations transdermal patches, subcutaneous implants of APs, and other long-acting devices like AP pumps since one of the primary reasons why patients reject LAIs is the fear of needles. ( DeRisio,2016). A radical change in attitude among clinicians and patients is required to reconsider LAI APs from a new perspective: no longer medications of last resort, but rather a potential first step to ensure treatment continuity and maximize clinical remission. This will help achieve and maintain clinical remission since patients in remission showed significantly better social functioning and quality of life. ( Agid, 2016).

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Discussion Response
Number of Pages	1 Page(s)/275 words
Sources	3
Format	APA
Spacing	Double Spacing

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