LAIs Are Not a Last Resort in Schizophrenia Treatment, Expert Says

Despite being a highly effective treatment option for schizophrenia, clinician bias has slowed the rate at which long-acting injectables have been adopted.

Psych Congress Network sat down with Veronica Ridpath, DO, chair of psychiatry and addiction medicine at Hope Health in Florence, South Carolina, to talk about why clinicians should be open to LAIs in their own practice. Dr Ridpath challenges clinician biases, showing that patients embrace LAIs more than we realize. Explore the power of finding common ground with patients and why LAIs should be considered early in treatment. 

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Read the Transcript

Veronica Ridpath, DO: My name is Dr Veronica Ridpath. I am the department Chair of Psychiatry and Addiction Medicine at Hope Health in Florence, South Carolina. 

Clinicians are our own worst enemies when it comes to the adoption of LAIs. Oftentimes the clinician attitudes towards LAIs are leading with some of these negatives of: it's an injection. [Patients] have to come in monthly, or however often it is. When we look at the data, patients are actually much more favorable for these medications than we think. So, if we get out of our own way, oftentimes, the adoption of these is much more seamless. 

Long-acting injectables can be given in any clinic setting and in any inpatient setting. They can be given at a patient's home, or they can be given in their car. There are very few true barriers to getting the patient the medication. 

Things like storage and reconstitution are oftentimes an education concern. If we have adequate education on preparation, administration, these are very accessible options for almost any treatment site. 

There's a common misconception that long-acting injectables are more poorly tolerated than oral medications, or that patients don't like the outcomes or the treatment effects. And really, when we look at the data, the long-acting injectables are just as well-tolerated and show better adherence and reduced risk of hospitalization compared to orals alone.  

It's important to find the common ground that you have with patients in order to start implementing these therapies. Oftentimes, your goals as a clinician and their goals as a patient are aligned. You want to keep them out of the hospital. You want them to have a good progression and not have relapses with their illness.  

When you're able to find that common ground with patients, it can be really effective tool to starting the motivational interviewing process, understanding that cognitive dissonance between what they're doing currently and where they want to be, and collaborating with the patient to get to that point where you are reaching their clinical goals.  

Long-acting injectable medications aren't scary. They aren't a last resort. They should be at the beginning of treatment. It should be something that we consider even before oral medications are started.  

For many people, these are life-changing medications that prevent the risk of relapse and worsening of the disease state. Every relapse is a disease-modifying event, so the more relapses we can prevent, the better. 

Every patient deserves to have the opportunity to trial these medications.   

Veronica Ridpath, DO, is a clinical associate professor at the University of South Carolina School of Medicine in the department of neuropsychiatry and behavioral science and serves as department chair for psychiatry and substance use at HopeHealth in Florence, South Carolina. Dr Ridpath graduated cum laude from University of North Carolina-Charlotte with a Bachelor of Science in psychology with minors in biology and classical studies. She obtained her Doctor of Osteopathic Medicine from Edward Via College of Osteopathic Medicine, where she was a National Health Service Corp scholar. Dr Ridpath has published and presented primarily in the areas of substance use, primary care and psychiatry integration, and medical student and resident education.