Schizophrenia Long-Acting Injectable Antipsychotic Initiation Index: A Clinician Rated Instrument for Improving Treatment in Schizophrenia

Abstract Background: Schizophrenia is a severe psychiatric condition with devastating consequences for the individual's functionality and leading to severe disability. Lack of insight and non-adherence to treatment remain the most important factors in the progression of the disease to chronicity.Despite their proven effectiveness in preventing relapses, reducing morbidity and mortality, long acting injectable antipsychotics (LAIs) are still underused. One of the causes invoked is the lack of guidelines or protocols for initiating LAIs.Objective: The aim of this article is to present Schizophrenia long-acting injectable antipsychotic initiation index (SLAII), a clinician-rated index that rates the important factors of the disorder across seven items: age, duration of illness, relapses, antipsychotic treatment response, family support, antipsychotic existing formulation and adherence.Method: A retrospective study in which all patients with schizophrenia discharged on oral antipsychotics without LAIs treatment lifetime were evaluated with SLAII for opportunity for LAIs initiation.Results: Of 225 consecutive patients, 144 patients (64%) had a strong indication for initiating LAI and 76 (34%) had moderate indication. 203 patients (90.2 %) had more than 2 relapses. The results of our research showed that 177 patients (78.7%) received at discharge an oral antipsychotic that also had a long-acting formula.Conclusion: This paper proposed an instrument designed to improve treatment in schizophrenia using a simple conceptual model which integrates important predictors of good or poor outcomes.