Attitudes of Italian psychiatrists towards the use of Long-Acting Injectable antipsychotics in the management of schizophrenia relapse: insights from the ALIA study

Abstract

Background: Long-Acting Injectable Antipsychotics (LAIs) represent a key strategy not only to enhance treatment adherence in patients with schizophrenia, but also to modify disease trajectories when initiated in the early phases of illness. However, LAIs remain still underutilized in clinical practice.

Methods: The Attitudes towards Long-Acting Injectable Antipsychotics of Italian Psychiatrists (ALIA) study surveyed psychiatrists across Italy to evaluate their attitudes towards LAIs use in the management of schizophrenia patients hospitalized due to a relapse.

Results: Of 173 eligible psychiatrists, 150 completed the survey. Main reasons for LAIs prescription included better post-discharge treatment adherence, stable drug levels, and improved symptoms control. LAIs were typically initiated after oral antipsychotic tolerability was confirmed or once the patient was clinically stabilized, often with a 7-day observation period. Key factors guiding LAI choice were efficacy, tolerability, and patient characteristics. Although 98 % of psychiatrists supported LAIs use early in the illness, recognizing their potential to improve long-term outcomes, barriers to LAIs prescription remain. These include diagnostic uncertainty at the first episodes of psychosis, limited number of active LAIs, poor dose flexibility, and risks of long-lasting adverse effects. Regarding patient and caregiver attitudes, psychiatrists identified prolonged drug presence in the body and a sense of being controlled as the main reasons for LAI refusal.

Conclusions: The ALIA study highlights that, despite the positive attitudes of Italian psychiatrists, significant barriers hinder LAIs use. Additionally, it emphasizes the importance of a shared decision-making in overcoming these barriers, fostering a collaborative approach between clinicians, patients and caregivers.

Keywords: Acute phase; Barriers' prescription; Long-Acting Injectable antipsychotics (LAIs); Psychiatrists' attitudes; Schizophrenia.