Early Use of Long-Acting Injectable Antipsychotics in Bipolar Disorder Type I: An Expert Consensus

Authors

Martha Sajatovic, Case Western Reserve UniversityFollow

Author ORCID Identifier

Martha Sajatovic

Document Type

Article

Publication Date

10-22-2024

Abstract

Introduction: Long-acting injectable antipsychotics (LAIs) are not routinely offered to patients living with bipolar disorder type I (BP-I), despite widespread evidence that supports their benefits over oral antipsychotics, particularly in early disease. Methods: A round-table meeting of psychiatrists convened to discuss barriers and opportunities and provide consensus recommendations around the early use of LAIs for BP-I. Results: LAIs are rarely prescribed to treat BP-I unless a patient has severe symptoms, sub-optimal adherence to oral antipsychotics, or has experienced multiple relapses. Beyond country-specific accessibility issues (e.g., healthcare infrastructure and availability/approval status), primary barriers to the effective use of LAIs were identified as attitudinal and knowledge/experience-based. Direct discussions between healthcare providers and patients about treatment preferences may not occur due to a preconceived notion that patients prefer oral antipsychotics. Moreover, as LAIs have historically been limited to the treatment of schizophrenia and the most severe cases of BP-I, healthcare providers might be unaware of the benefits LAIs provide in the overall management of BP-I. Improved treatment adherence associated with LAIs compared to oral antipsychotics may support improved outcomes for patients (e.g., reduced relapse and hospitalization). Involvement of all stakeholders (healthcare providers, patients, and their supporters) participating in the patient journey is critical in early and shared decision-making processes. Clinical and database studies could potentially bridge knowledge gaps to facilitate acceptance of LAIs. Conclusion: This review discusses the benefits of LAIs in the management of BP-I and identifies barriers to use, while providing expert consensus recommendations for potential solutions to support informed treatment decision-making.

Keywords

antipsychotics, bipolar disorder type 1, consensus, patient-reported outcome measures, psychosis, shared decision-making, treatment adherence and compliance

Language

English

Publication Title

Bipolar Disorders

Rights

© The Author(s) 2024. This is an Open Access work distributed under the terms of the Creative Commons Attribution Licence (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Vieta E, Tohen M, McIntosh D, KessingLV, Sajatovic M, McIntyre RS. Early use of long-acting injectableantipsychotics in bipolar disorder type I: An expert consensus.Bipolar Disord. 2025;27:7-16. doi:10.1111/bdi.13498