The British Journal of Psychiatry (2009) 195: S1-S4. doi: 10.1192/bjp.195.52.s1
© 2009 The Royal College of Psychiatrists
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EDITORIALS

Antipsychotic long-acting injections: mind the gap

Maxine X. Patel, MSc, MRCPsych

Division of Psychological Medicine, Institute of Psychiatry, King's College London

Mark Taylor, BSc(Hons), FRCPsych, FRANZCP

Ballenden House, Edinburgh

Anthony S. David, MSc, MD, FRCPsych, FRCP

Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK

Correspondence: Dr Maxine Patel, Division of Psychological Medicine, Box 68, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Email: m.patel{at}iop.kcl.ac.uk

Declaration of interest

M.X.P. and A.S.D. have been reimbursed for attendance at scientific conferences and have received consultation fees from Janssen-Cilag and Eli Lilly. They have also received investigator-initiated grants from Janssen-Cilag and Eli Lilly and have previously worked on two clinical drug trials for Janssen-Cilag. M.T. has received hospitality and advisory or speaker fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Janssen-Cilag within the past 5 years.

Long-acting injections of antipsychotic medication (or depots) were developed specifically to promote treatment adherence and are a valuable option for maintenance medication in psychotic illnesses. Approximately 40–60% of patients with schizophrenia are partially or totally non-adherent to their antipsychotic regimen, but only 30% or less are prescribed a long-acting injection. The use of such injections has declined in recent years after the introduction of second-generation (atypical) oral antipsychotic drugs. Research shows that possible reasons for this decline include concerns that may be based on suboptimal knowledge, as well as an erroneous assumption that one's own patient group is more adherent than those of one's colleagues. Research on attitudes has also revealed that psychiatrists feel that long-acting injections have an `image' problem. This editorial addresses the gaps in knowledge and behaviour associated with possible underutilisation of these formulations, highlighting the role of stigma and the need for more research.