18 What Treatment Would You Prefer if You Were Experiencing a Psychotic Episode? Survey of a Population of Psychiatrists

Abstract

Rate of treatment non-compliance in schizophrenia, like in other chronic diseases. Long-acting injectable (LAI) antipsychotics have proven to be more effective than orals in reducing the number of recurrences. Although the perception of LAIs has changed over the last few years with the introduction of new molecules, there might be prejudices regarding these formulations within the mental health professionals community. The exercise of imagining how and with which antipsychotic you would like to treat yourself or a close relative in case of suffering from schizophrenia, can help to emerge true prescription preferences.

The objective of the present work is to assess the psychiatrists antipsychotics prescribing preferences for schizophrenia, in the hypothetical case they were patients suffering a 2nd/3rd relapse. With this purpose, we performed an on-line survey in a sample of psychiatrists and trainees fromSpain.

Results showed that election of LAIs were less frequent for in Self-prescription scenario, both for the 2nd and 3rd hypothetical recurrence. Also, psychiatrist who chose LAIs for their patients are more likely to choose orals for themselves (p=0.039; p<0.001 for 2nd and 3rd recurrence respectively). The most preferred LAI for both patients and self-prescription was aripiprazole once-monthly (60% and 87% respectively).

Interestingly, nearly 70% of psychiatrist choosing a LAI different form Aripiprazole, would change the prescription for themselves; and those choosing aripiprazole once-monthly for their patients were more likely to maintain it for themselves (p<0.001). Practitioners changing from LAIs to orals in the self-treatment scenario perceive LAIs as a more coercive measure (p<0.01), being the degree of coercitivity perceived the only variable associated with a change in prescription's decisions (p=0.002). Curiously, LAIs associated coercitivity was significantly lower for oncologist vs psychiatrists (p<0.001). The level of weight gain, metabolic problems, extrapyramidal symptomatology, sexual dysfunction, sedation and cognitive problems perceived by psychiatrists is significantly lower for Aripiprazole than for the rest of LAIs (p <0.01 for all comparisons), with a comparable perceived efficacy (mean=3.95 and 4 out of possible 5, p=0.7). In light of our results, this is partially explained by a perception of LAIs as coercive measures, in contrast with perception of similar treatments for the control of somatic diseases. The fact of imagining a scene where oneself is the one suffering from a disease, shows preferences in the use of psychotropic drugs for the management of schizophrenia where the profile of side-effects and efficacy has a more equitable balance: starting from comparable effectiveness, we prefer treatments associated with a perception of fewer side-effects