Relapse prevention

Question 1

Why is it important to try to prevent relapse?

Answer 1

Correll et al., 2018
More relapse episodes predict development of chronic illness = less chance for recovery, less response to medication
Each relapse episode removed the person form society increasing the effect of them + makes it harder to go back
They increase risk of suicide attempts
Brain structure decline
More societal costs
Higher burden for family and/or caregivers

Question 2

What is shared decision making (SDM)?

Answer 2

Continuum from clinician-led/passive/paternalistic through to patient-led/active/informed.

Key thing here is that it is a collaboration between the clinicians, the patient and possibly their family.

Patients prefer SDM to clinician-led decision making.

Widely supported across medicine leading to better outcomes, increased concordance with treatment plans, reduced stigma and increased involvement from patients and it is supported at the police level in mental health.

Shared decision making in mental health care involves clinicians and patients working together to make decisions.

Often guided by RCTs and other evidence + sometimes by clinician’s judgement and expertise

Question 3

What are the components of SDM?

Answer 3

• Define/explain the health care problem
• Present options
• Discuss benefits/risks/costs + be transparent about them
• Clarify patient values/preferences
• Discuss patient ability/self-efficacy
• Present what is known and make recommendations
• Clarify the patient’s understanding
• Make or explicitly defer a decision

Question 4

LAIs

Answer 4

2-4 weeks or even every few months

Usually don’t start with DEPOT because you can’t stop them = need to establish efficacy and dosage of anitipsychotics in oral form

Caroli et al. 2011 70% of patients felt better supported in their illness BUT there could be some stigma (if history of admired to hospital and being forcefully given the shot)

With 1st gen some people need a “loading dose”= small dose because some people can be allergic to oil in it

Paliperidone is an active metabolite of Risperidone which allows the switching between the 2 and extending the time between doses

Some people can get a risk of post-injection syndrome (feeling dizzy, sedated due to spike in dose right after the shot = need for monitoring after the shot)

Given to the patent at home (butt or shoulder) to the muscle

Question 5

Advantages of LAIs

Answer 5

1. Possible decrease or relapse (no need to remember about it) and hospitalisation rates
2. No question about adhesion
3. Continuous administration of the antipsychotic
4. Confidentiality - no need to take the pill all the time

Question 6

Disadvantages of LAIs

Answer 6

1. Negative clinical appraisals
2. Not possible to stop dosage if side effects
3. Stigma
4. Fear of pain
5. Need to transition from oral to DEPO