Challenges and Limitations When Using Oral Antipsychotics in Bipolar Disorder Treatment

Discover the hidden challenges of conventional oral antipsychotic treatments for bipolar disorder and the impact on patient adherence. In this video, Christoph Correll, MD, professor of psychiatry at Hofstra Northwell School of Medicine, New York, and medical director of the Recognition and Prevention program at the Zucker Hillside Hospital, New York, discusses the potential of long-acting injectables (LAIs) in reshaping treatment strategies, including the criteria for identifying ideal candidates and how LAIs could redefine stability and empowerment for patients. 

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Read the Transcript:

Meagan Thistle, Psych Congress Network: What are the challenges and limitations associated with conventional oral antipsychotic treatments for bipolar disorder, and how do these challenges contribute to treatment non-adherence among patients?

Christoph Correll, MD: Patients with bipolar disorder, like many patients with severe mental illness, don't always have an easy time taking their medications. They might have questions. "Do I really have the illness?" Or they feel impaired by the side effects and might forget because of cognitive dysfunction. The oral treatments that can work in research settings don't always have the same efficacy in the real world because patients are partially or fully non-adherent. Let's face it. Non-adherence is part of the human condition. You and I are non-adherent with many things we should be doing. That's where long-acting injectables come in.

We may think of them mostly for schizophrenia, but even in bipolar disorder, antipsychotics are a building block of treatment. LAIs should be considered and at least offered. Now, you might say, "Wait a second. But many of my patients need more than one just mood stabilizing agent. How would it help to just have one LAI? I still have to prescribe conventional mood stabilizers or what have you." Well, we found that, at least in schizophrenia, when you have this seatbelt, and people have a much easier illness course, they're responding, they're not only more adherent to the antipsychotic. It spills over, and they're also more adherent to the other medications. In that sense, LAIs in bipolar disorder can help stability and, with the stability, help patients achieve their goals.

Thistle, PCN: What are some factors that make certain patients with bipolar disorder I more suitable candidates for LAI treatment as opposed to oral medications?

Dr Correll: I often get the question, "Who's the perfect patient for X?" With LAIs, "What profile would predestine someone that you should think of an LAI?" I would turn this around and just rather ask, "Which patients should you not think about an LAI?" There are very few because non-adherence is common. You also want convenience that patients don't have to think about taking the medication, having to be reminded that they are ill if they're, for example, in college and other people are around them, that they're seen being taking the medication. So I think there are many patients that are eligible. You only know who might be agreeable after you've offered them and discussed with the patients their goals and how stability of the symptoms and regular intake of the medications might actually fit with their goals.

Christoph Correll, MD, is a professor of psychiatry at Hofstra Northwell School of Medicine, New York, and medical director of the Recognition and Prevention program at the Zucker Hillside Hospital, New York. Dr Correll completed his medical studies at both the Free University of Berlin in Germany and at the Dundee University Medical School in Scotland. Dr Correll is board-certified in general psychiatry, having completed his residency at The Zucker Hillside Hospital in New York City.