Dr. Rakesh Jain on Using LAIs in Patients With Dementia and Delusions

In this video, Psych Congress Steering Committee member Rakesh Jain, MD, MPH, answers the following question:

"I work on an inpatient, geriatric unit with a majority of the patients having dementia. Many are nonadherent to their medication due to paranoia and other delusions. What do you think about using [long-acting injectables] in this population?

Dr. Jain is Clinical Professor, Department of Psychiatry, Texas Tech Health Sciences Center School of Medicine, Midland.

Read the transcript:

Hello, dear colleagues. Here is a question I often get asked. "I work on an inpatient geriatric unit with the majority of the patients having dementia. Many are nonadherent to their medication due to paranoia or other delusions. What do you think about using LAIs in this population?"

What a great question, a complicated one. Here are some of my thoughts. Please remember there is, of course, a bolded black box warning about the use of atypicals in our patients with dementia-related psychosis.

Having said that, if the situation does demand it, it is not a contraindication. You are right. Sometimes, oral medications can be a challenge, as you described, in making sure the patient actually receives a medication that is often sometimes literally life-saving and improves the quality of their life.

Once you have appropriate informed consent from the patient and/or if there is a legal guardian involved, the use of a long-acting injectable is actually entirely appropriate. Certainly, you may want to consider the risk-benefit ratio, using the minimum doses, getting a very thorough informed consent, and documentation thereof, in your records.

With all that said, remember, at the end of the day, a long-acting injectable is really an antipsychotic you would have given anyways on an oral basis. The answer to your question is “yes,” but do exercise extra caution, as I have suggested.

Thank you for asking that question.

In this occasional feature, members of the Psych Congress Steering Committee and faculty answer questions asked by attendees at Psych Congress meetings.

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