Current schizophrenia treatment protocols face significant limitations despite decades of clinical use, prompting healthcare providers to advocate for long-acting injectable antipsychotics as a new standard of care. While traditional approaches combining daily oral antipsychotics with cognitive behavioral therapy demonstrate effectiveness in managing positive symptoms like hallucinations and delusions, they often provide only partial efficacy and may worsen negative symptoms and cognitive impairments that most severely impact patient functioning and quality of life.
Treatment Limitations Drive Need for Change
The standard of care creates a challenging risk-benefit balance for clinicians and patients. Medication side effects include metabolic issues, weight gain, cognitive blunting, and emotional numbing that patients describe as feeling like "zombies." These adverse effects frequently lead to medication non-adherence, creating a cycle where patients discontinue treatment due to side effects, experience symptom relapse, and require hospitalization.
Healthcare providers must navigate these treatment challenges while recognizing that schizophrenia is a neurodegenerative condition requiring lifelong management rather than cure. The goal shifts from complete symptom elimination to functional improvement and preventing further brain deterioration.
Long-Acting Injectables Show Promise
Long-acting injectable (LAI) antipsychotics represent an underutilized treatment option that could address many current limitations. Recent reports show there are currently 3.5 million people diagnosed with schizophrenia, but only about 10% of patients are on an LAI. Healthcare providers believe there may be hesitancy to prescribe LAIs due to a lack of awareness, clinical experience, and resources.
The majority of oral medications prescribed to treat schizophrenia are taken on a daily basis, meaning non-adherence will not be detected until a major problem develops. In contrast to oral medications, LAIs have a variety of dosing schedule options, which are often more suitable to patient lifestyles.
Clinical Experience Supports LAI Adoption
Psychiatrists report witnessing LAIs improve symptoms and prevent relapses which can lead to hospitalizations and other serious outcomes. One such treatment frequently prescribed is ARISTADA (aripiprazole lauroxil), a prescription medicine given by injection by a healthcare professional and used to treat schizophrenia in adults. This medication is available in several different doses including monthly (441 mg, 662 mg, 882 mg), every 6 weeks (882 mg), and every 2 months (1064 mg), allowing clinicians to tailor each treatment regimen to patient needs.
In patients with schizophrenia taking ARISTADA, healthcare providers have observed a reduction in symptoms such as delusions, social withdrawal, and hallucinations. More importantly, they have witnessed improved adherence rates and feel the reduced dosing schedule offers a convenient option for patients.
Addressing Implementation Barriers
Treatment for schizophrenia requires collaboration between the individual and healthcare professional to establish an individualized treatment plan. Some patients may experience "anosognosia," or a lack of insight into their illness, which complicates treatment decisions. Additionally, people living with schizophrenia often experience stigma related to their diagnosis, which can result in social exclusion and impact their relationships with others.
Healthcare providers strongly advocate for LAIs to be considered as an option both early in a patient's treatment journey and for the long-term maintenance of their disease. Earlier and improved education among the healthcare community is identified as a pivotal first step, followed by patient and caregiver partnership in the decision-making process.
Future Treatment Paradigm
Despite the significant challenges in schizophrenia treatment, healthcare providers believe that incorporating LAIs into clinical practice can improve the treatment experience for individuals living with this complex mental health condition. While there is no cure for schizophrenia, with the right care plan and supportive care team, patients can have the opportunity to live meaningful and productive lives.
The shift toward LAIs as standard of care represents recognition that current treatment modalities must evolve to address unmet needs in negative symptom management and cognitive enhancement while minimizing debilitating side effects that compromise patient adherence and outcomes.
