Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa

Abstract

Background: Long-acting injectable antipsychotics (LAI – APs) improve adherence to antipsychotics and decrease functional decline in schizophrenia. Yet they are prescribed late, in patients with established functional decline. Although LAI – APs are widely prescribed in South Africa, there is a paucity of research regarding the prescription profile for LAI – APs. Aim: This study aimed to describe prescribing practices for LAI – APs at psychiatric clinics. Setting: Community psychiatric clinics in South Africa. Methods: A retrospective review of the psychiatric files of all patients on LAI – APs attending the clinics over the study period was conducted. Sociodemographic, clinical and pharmacological information regarding the LAI – AP prescribed was extracted from the files. Results: A total of 206 charts were examined. The mean age of the study population was 46 (SD ± 12) years. Significantly more patients were male (n = 154; 74.8%), single (n = 184, 89.3%) and unemployed (n = 115; 55.8%) (p < 0.001). Approximately half had a comorbid substance use disorder (47.6%). The most common indication for the prescription of a LAI – AP was non-adherence (66%). Only 9.7% of the patients were prescribed a LAI – AP alone. No significant socio-demographic or clinical characteristic was associated with this prescribing habit. A LAI – AP was prescribed in combination with an oral antipsychotic, mood stabiliser or antidepressant in 53.9%, 44.7% and 7.8% of patients, respectively. Conclusion: Long-acting injectable antipsychotics were prescribed mainly following noncompliance with oral antipsychotics and may represent a missed opportunity to prevent functional decline. The high prevalence of LAI – AP polypharmacy has been highlighted.