Clinical Dilemmas in Schizophrenia Treatment and the Potential Place in Therapy of Long-acting Antipsychotic Agents

Abstract: Introduction: Treatment nonadherence in schizophrenia is a continuing challenge, but can be improved with use of long-acting injectable antipsychotic agents (LAIs). Although well-documented data support the utility of LAIs in schizophrenia management, their use is often limited by a lack of clarity on their place in therapy. In addition to treatment nonadherence, there are a variety of other clinical dilemmas that clinicians may face when treating patients with schizophrenia. Education for clinicians on use of LAIs in these contexts and on how to address these clinical dilemmas is important for improving patient outcomes. Methods: A panel of 4 experts was formed to identify 10 key clinical dilemmas (scenarios) in schizophrenia management where LAI treatment may be useful based on empirical evidence. The experts then developed a heuristic tool (the Schizophrenia Clinical Outcome Scenarios and Patient-Provider Engagement [SCOPE] framework) of considerations that physicians may use when facing these dilemmas. Results: The SCOPE framework includes considerations for shared decision making, monitoring of adverse effects, and use of alternative antipsychotic formulations when needed, including use of LAIs. Several clinical scenarios assessed using the SCOPE framework will be presented as examples of how to apply it to common clinical dilemmas. Conclusions: The SCOPE framework is an educational tool that can be used by clinicians treating patients with schizophrenia along with standard psychiatric evaluations in inpatient and outpatient settings to help them to better understand how to manage common clinical dilemmas and the place in therapy for LAIs in schizophrenia treatment.Short Description: Treatment nonadherence is a continuing challenge for patients with schizophrenia. A panel of experts identified 10 key clinical dilemmas (scenarios) in schizophrenia management where treatment with long-acting injectable antipsychotic agents may address the dilemma based on empirical evidence. They then developed a heuristic tool—the Schizophrenia Clinical Outcome Scenarios & Patient-Provider Engagement (SCOPE) framework—of considerations that physicians may use when facing these dilemmas.Name of Sponsoring Organization(s): Teva Branded Pharmaceutical Products R&D, Inc.