Table 2.
Expert consensus on selecting patients with schizophrenia/schizoaffective disorder who are appropriate for LAI treatment based on treatment history
| Rating | Patient with schizophrenia/schizoaffective disorder treated with antipsychotic medication for ≥2 years (mean [SD] ratinga)
|
|
|---|---|---|
| Assumed treatment adherence | Questionable treatment adherence | |
| First line | Prefers LAI (8.8 [0.6]) | Prefers LAI (8.8 [0.5]) |
| Has done well on LAI in the past (8.4 [0.9]) | Has done well on LAI in the past (8.3 [1.3]) | |
| Conflict in family related to adherence to oral medication (8.4 [0.9]) | Conflict in family related to adherence to oral medication (8.3 [1.1]) | |
| Frequently misses clinic appointments (8.1 [1.1]) | Frequently misses clinic appointments (8.3 [1.0]) | |
| Family/care partner does not support antipsychotic treatment regimen (7.5 [2.0]) | Family/care partner does not support antipsychotic treatment regimen (7.6 [1.8]) | |
| Patient with whom I have a good therapeutic alliance (7.1 [1.7]) | Patient with whom I have a good therapeutic alliance (7.6 [1.5]) Has done well on oral antipsychotic medications in the past but has never been treated with an LAI (7.5 [1.3]) Concomitant maintenance treatment with other psychotropic medications (eg, mood-stabilizing agents, antidepressants) (7.5 [1.8]) Positive symptoms (hallucinations, delusions) have responded well to oral antipsychotic medications, but patient continues to have negative symptoms or cognitive symptoms/impairment (7.2 [1.6]) |
|
| High second lineb | Concomitant maintenance treatment with other psychotropic medications (eg, mood-stabilizing agents, antidepressants) (6.6 [1.7]) | Positive symptoms (hallucinations, delusions) have not responded to previous trials of oral antipsychotic medications (7.2 [2.2]) |
| Patient with whom I do not have a strong therapeutic alliance (6.6 [2.1]) | Patient with whom I do not have a strong therapeutic alliance (7.1 [1.9]) | |
| Positive symptoms (hallucinations, delusions) have responded well to oral antipsychotic medications, but patient continues to have negative symptoms or cognitive symptoms/impairment (6.5 [2.0]) | Patient being treated with an antipsychotic indicated for treatment-resistant schizophrenia but is still experiencing positive symptoms (6.5 [2.4]) | |
| Positive symptoms (hallucinations, delusions) have not responded to previous trials of oral antipsychotic medications (6.5 [2.3]) Has done well on oral antipsychotic medications in the past but has never been treated with an LAI (6.5 [2.0]) Patient being treated with an antipsychotic indicated for treatment-resistant schizophrenia but is still experiencing positive symptoms (6.2 [2.4]) History of refusing treatment with LAI (6.1 [2.1]) |
History of refusing treatment with LAI (6.5 [2.0]) | |
Notes:
a
Rating scale: 1 = extremely inappropriate, 2–3 = usually inappropriate, 4–6 = sometimes appropriate, 7–8 = usually appropriate, 9 = extremely appropriate; bold indicates an option rated 9 by ≥50% of the experts.
b
High second-line options are those for which the upper value of the CI is ≥6.5, the boundary for first line.
Abbreviation: LAI, long-acting injectable antipsychotic.