A Look at LAI Antipsychotics for Bipolar I Disorder: A Preview of the Psych Congress

Long-acting injectable (LAI) antipsychotics are an important yet underutilized treatment option for patients with bipolar I disorder. This is partly due to the lack of awareness that this method can be used outside the treatment of schizophrenia and to knowledge gaps surrounding strategies for recognizing patients who could benefit from this treatment option.

To address these gaps, Dr. Christoph U. Correll, Professor of Psychiatry and Molecular Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Dr. Veronica Ridpath, a psychiatrist at HopeHealth Medical Plaza, will present a session at the 2022 Psych Congress to explain the importance of LAIs, their role in patient care, and which patients could benefit from this treatment option.

But before the Congress, let’s review what we know so far about the use of LAIs in bipolar I disorder.

What Are Long-Acting Injectable Antipsychotics?

LAIs have been around for quite some time and are essentially the same as oral antipsychotic medication except for how they’re administered. LAIs are an intramuscular injection, and patients can receive them in a frequency anywhere from two weeks to six months. 

However, the concerns with any psychiatric condition are nonadherence to medication and relapse of symptoms.

“By treating patients with this kind of antipsychotic treatment, we can get good results in many patients. However, we also know that patients—either because they're forgetting, maybe because they do not accept that they have illness, or they think that when they are better, this will stay—do not always take the medication as prescribed,” said Dr. Correll.

He goes on to say that “More relapses are associated with a shrinkage of the gray matter. There is less brain to rehabilitate. More relapses are also associated with less treatment response. Patients who have responded before, 1 in 6 to 1 in 7 patients, will not respond as well to antipsychotic treatment after a relapse—secondary treatment resistance.”

To achieve continuous treatment with antipsychotics, data has shown that LAIs are superior to oral medications in terms of prevention of relapse and hospitalization as well as reducing the risk of mortality.

Benefits to Bipolar I Disorder & Strategies for Patient Care

Bipolar disorder is a psychiatric condition that causes unusual shifts to mood, energy and activity levels, concentration, and inability to complete day-to-day tasks. Bipolar I is categorized by manic episodes that last at least 7 days or severe symptoms that require immediate hospital care.

Much like with schizophrenia, patients with bipolar I disorder can struggle with relapse and nonadherence for many reasons, including failure to remember to take medication, not wanting to feel the effects of antipsychotics, or certain beliefs that require psychoeducation.

Although the benefits of LAIs are clear, data also shows that 70 percent or more patients with schizophrenia have never been offered this medication, and the numbers are even higher for those with bipolar 1 disorder.

Dr. Correll says the key to offering LAIs to patients is motivational interviewing.

“We're trying to motivate someone to make a change that helps them achieve their goals, not necessarily ours.

In order to understand what their goal is, we need to ask open-ended questions, try to be understanding and not judgmental, but listening for our way in to communicate that symptom stability and lack of relapse is more likely to get patients what they want.”

Other strategies for introducing LAIs include:

• Speaking with the patient about benefits of LAIs over the course of multiple visits.
• Involving a family member who has been educated on LAIs and can further talk to the patient about it.
• Introducing a peer counselor who has experienced the benefits of LAIs and can communicate that to the patient.

More is to come at this year’s Psych Congress, so stay tuned for even more updates regarding LAIs for patients with bipolar I disorder.

References:

Correll, Christoph. “Exploring the Challenges and Opportunities Offered by LAIs in Schizophrenia and Bipolar Disorder.” Hmpgloballearningnetwork.com. Psych Congress Network, April 19, 2021. https://www.hmpgloballearningnetwork.com/site/pcn/multimedia/exploring-challenges-and-opportunities-offered-lais-schizophrenia-and-bipolar-disorder.