Guidelines for the Treatment of Schizophrenia

Transcript: John M. Kane, MD: The 2004 guidelines that the APA [American Psychological Association] published for the treatment of schizophrenia underemphasizes the potential value of long-acting injectable formulations. They indicate they are reserved for patients who demonstrated nonadherence by relapsing multiple times. That is a conservative approach. Once someone has already experienced relapses due to nonadherences, we’ve lost the battle. We want to prevent every relapse we can because the relapses can be so devastating. I’m not saying we can prevent 100% of relapses.

When someone is receiving a long-acting injectable formulation, there still is risk of relapse or breakthrough, but we can reduce the risk enormously. We should be less conservative in the use of long-acting formulations because there is no reason not to use them. There are no disadvantages in terms of [adverse] effects, so we should be asking ourselves why not use them? I’m hoping that the new APA guidelines, which have not been finalized yet, will have a more proactive approach to the use of long-acting formulations.

We’ve provided feedback to the APA regarding this issue. I hope they’re going to respond to some of the suggestions that we’ve made, but I have not seen a final draft.

Dawn Velligan, PhD: The National Council for Behavioral Health [NCBH] has developed guidelines for long-acting injection, which I support. I have been a big fan of long-acting injection since I used to do NIH [National Institutes of Health] trials. We would go to people’s houses and they had no idea how they were supposed to take their medication. I’ve been a proponent for long-acting injection. The council's guidelines suggest that you need to use long-acting injection earlier and more often, and long-acting injection can make sure that the medicine is getting into the person. It can ensure that they're able to have stable medication so that they can work on their recovery. The council guidelines suggest using it with recent onset, first episode patients. They suggest using it with anybody who prefers a long-acting [medication], anybody who has trouble taking medication daily, which is a lot more people than I think many providers recognize. Providers have a hard time recognizing who's adherent and who's not adherent. I recommend the guidelines of the National Council for Behavioral Health. I’d ask my patients, “Do you want a pill? Do you want an injection? These are the pros and cons,” and they could make a good choice about it.

Transcript Edited for Clarity